Healthcare Provider Details

I. General information

NPI: 1396369906
Provider Name (Legal Business Name): WILLIS F GAFFNEY M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
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: 989-607-6875
Mailing address:
  • Phone: 989-831-9009
  • Fax: 989-607-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRINE BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 989-831-9009