Healthcare Provider Details

I. General information

NPI: 1811235591
Provider Name (Legal Business Name): WILLIS F GAFFNEY M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S SHERIDAN RD
STANTON MI
48888-9285
US

IV. Provider business mailing address

2939 S SHERIDAN RD
STANTON MI
48888-9285
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-9009
  • Fax: 989-831-9150
Mailing address:
  • Phone: 989-831-9009
  • Fax: 989-831-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301050158
License Number StateMI

VIII. Authorized Official

Name: WILLIS FAYNE GAFFNEY
Title or Position: PHYSICIAN/OWNER
Credential: M.D. P.C
Phone: 989-831-9009