Healthcare Provider Details

I. General information

NPI: 1346772688
Provider Name (Legal Business Name): TINA GEROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S GULLEY RD SUITE E
DEARBORN MI
48124-4407
US

IV. Provider business mailing address

1133 FOREST AVE
BURTON MI
48509-1903
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-2327
  • Fax:
Mailing address:
  • Phone: 810-931-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: