Healthcare Provider Details

I. General information

NPI: 1871663369
Provider Name (Legal Business Name): STEVEN N GERVAE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S 7TH ST
ONTONAGON MI
49953-1450
US

IV. Provider business mailing address

751 S 7TH ST
ONTONAGON MI
49953-1450
US

V. Phone/Fax

Practice location:
  • Phone: 906-884-2824
  • Fax: 906-884-2861
Mailing address:
  • Phone: 906-884-2824
  • Fax: 906-884-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberSG028728
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN NORMAN GERVAE
Title or Position: OWNER
Credential: M.D., P.C.
Phone: 906-884-2824