Healthcare Provider Details

I. General information

NPI: 1710079256
Provider Name (Legal Business Name): GERALYN DOSKOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 W UPRIGHT ST
CHARLEVOIX MI
49720-1949
US

IV. Provider business mailing address

14705 W UPRIGHT ST
CHARLEVOIX MI
49720-1949
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-6520
  • Fax: 231-547-5404
Mailing address:
  • Phone: 231-547-6519
  • Fax: 231-547-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301065473
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301065473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: