Healthcare Provider Details

I. General information

NPI: 1790300275
Provider Name (Legal Business Name): CARA CAWLEY GUMINIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SERVICE RD STE A217
EAST LANSING MI
48824-7015
US

IV. Provider business mailing address

804 SERVICE RD STE A202
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-8122
  • Fax: 517-432-3713
Mailing address:
  • Phone: 517-353-8122
  • Fax: 517-432-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number5101027989
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: