Healthcare Provider Details

I. General information

NPI: 1952392896
Provider Name (Legal Business Name): CRAIG J GORDON, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30160 ORCHARD LAKE RD STE 100
FARMINGTON HILLS MI
48334-2254
US

IV. Provider business mailing address

30160 ORCHARD LAKE RD STE 100
FARMINGTON HILLS MI
48334-2254
US

V. Phone/Fax

Practice location:
  • Phone: 248-522-0222
  • Fax: 248-522-0225
Mailing address:
  • Phone: 248-522-0222
  • Fax: 248-522-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberCG008584
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberSS065453
License Number StateMI

VIII. Authorized Official

Name: MRS. SUE HUDEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-522-0222