MEDICARE: ARBOR LANE FAMILY PHYSICIANS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	GG034127	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205835931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARBOR LANE FAMILY PHYSICIANS PLC

Provider Business Mailing Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE C302
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-561-0550
Fax Number	:	313-561-3646

Provider Business Practice Location Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE C302
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-561-0550
Fax Number	:	313-561-3646

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. GARY GAZELLA
Credential	:	MD
Telephone Number	:	313-561-0550

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	04/07/2008

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