MEDICARE: GALINA GAGIN PRIMEAU MD

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	390200000X	Student in an Organized Health Care Education/Training Program	4301114708	MI

General Provider Information

NPI Number	:	1770073140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALINA GAGIN PRIMEAU MD

Provider Business Mailing Address
First Line	:	1500 E. MEDICAL CENTER DRIVE
Second Line	:	2130 TC
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-5340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 E. MEDICAL CENTER DRIVE
Second Line	:	2130 TC
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-5340
Country	:	US
Telephone Number	:	734-998-6022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	05/11/2018

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