Healthcare Provider Details

I. General information

NPI: 1881328268
Provider Name (Legal Business Name): EVGENY GELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29201 TELEGRAPH RD STE 606
SOUTHFIELD MI
48034-1300
US

IV. Provider business mailing address

29201 TELEGRAPH RD STE 606
SOUTHFIELD MI
48034-1300
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-8610
  • Fax: 248-356-6473
Mailing address:
  • Phone: 248-356-8610
  • Fax: 248-356-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4352001083
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number4301511951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: