Healthcare Provider Details

I. General information

NPI: 1811334386
Provider Name (Legal Business Name): JOSHUA GAFFNEY LIROFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

1725 HAMILTON DR
BLOOMFIELD HILLS MI
48302-0222
US

V. Phone/Fax

Practice location:
  • Phone: 517-817-7060
  • Fax: 517-817-7050
Mailing address:
  • Phone: 248-505-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101020502
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101020502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: