Healthcare Provider Details

I. General information

NPI: 1104863190
Provider Name (Legal Business Name): GERALD E TURLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 5B UNIVERSITY HEALTH CENTER
DETROIT MI
48201-2153
US

IV. Provider business mailing address

1560 E MAPLE ROAD SUITE 400-CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 888-264-0102
  • Fax: 313-745-8165
Mailing address:
  • Phone: 313-745-1741
  • Fax: 313-745-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301047021
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301047021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: