Healthcare Provider Details

I. General information

NPI: 1144205725
Provider Name (Legal Business Name): JOSEPH GELINA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N MILL ST
SAINT LOUIS MI
48880-1523
US

IV. Provider business mailing address

224 N MILL ST
SAINT LOUIS MI
48880-1523
US

V. Phone/Fax

Practice location:
  • Phone: 989-681-3524
  • Fax:
Mailing address:
  • Phone: 989-681-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberJG001405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: