MEDICARE: CRAIG J GORDON, D.O., P.C.

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	207RH0003X	Hematology & Oncology Physician	CG008584	MI
2	207RH0003X	Hematology & Oncology Physician	SS065453	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OF37505	OTHER	MI	BCBS
2	5679150	OTHER	MI	AETNA
3	P6078	OTHER	MI	BCN
4	P88665	OTHER	MI	BCN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952392896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG J GORDON, D.O., P.C.

Provider Business Mailing Address
First Line	:	30160 ORCHARD LAKE RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2254
Country	:	US
Telephone Number	:	248-522-0222
Fax Number	:	248-522-0225

Provider Business Practice Location Address
First Line	:	30160 ORCHARD LAKE RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2254
Country	:	US
Telephone Number	:	248-522-0222
Fax Number	:	248-522-0225

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. SUE HUDEL
Credential	:
Telephone Number	:	248-522-0222

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/04/2019

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Directions to “CRAIG J GORDON, D.O., P.C. ” Practice Location

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