Healthcare Provider Details

I. General information

NPI: 1942263843
Provider Name (Legal Business Name): IRVIN J. GASTMAN DO, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20901 W 7 MILE RD
DETROIT MI
48219-1904
US

IV. Provider business mailing address

18000 W 9 MILE RD STE 200
SOUTHFIELD MI
48075-4020
US

V. Phone/Fax

Practice location:
  • Phone: 313-564-5510
  • Fax: 248-336-9137
Mailing address:
  • Phone: 248-336-4000
  • Fax: 248-336-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number5101007321
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberIG007321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: