Healthcare Provider Details

I. General information

NPI: 1306541016
Provider Name (Legal Business Name): LUCAS MATTHEW GELMINI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KERCHEVAL AVE
GROSSE POINTE FARMS MI
48236-3629
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2621
  • Fax: 313-343-5992
Mailing address:
  • Phone: 800-653-6568
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101029429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: