Healthcare Provider Details

I. General information

NPI: 1285667337
Provider Name (Legal Business Name): BRIAN J GEDEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E STATE ST
STERLING MI
48659-9548
US

IV. Provider business mailing address

725 E STATE ST
STERLING MI
48659-9548
US

V. Phone/Fax

Practice location:
  • Phone: 989-654-2491
  • Fax: 989-654-2190
Mailing address:
  • Phone: 989-654-2491
  • Fax: 989-654-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301072128
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301072128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: