Healthcare Provider Details

I. General information

NPI: 1487868600
Provider Name (Legal Business Name): RHONDA ANDREW GUMMA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49650 CHERRY HILL RD STE 240
CANTON MI
48187-4849
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR PO BOX 0446 LOBBY J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-398-7880
  • Fax:
Mailing address:
  • Phone: 734-327-0872
  • Fax: 734-747-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101017051
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: