Healthcare Provider Details

I. General information

NPI: 1811158280
Provider Name (Legal Business Name): ROBERT I GANS, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26615 GREENFIELD RD
SOUTHFIELD MI
48076-7201
US

IV. Provider business mailing address

26615 GREENFIELD RD
SOUTHFIELD MI
48076-7201
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-1070
  • Fax: 248-557-4984
Mailing address:
  • Phone: 248-557-1070
  • Fax: 248-557-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number022712
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number022712
License Number StateMI

VIII. Authorized Official

Name: MRS. MARY PATRICIA ARNETT
Title or Position: BILLER
Credential:
Phone: 248-557-1812