Healthcare Provider Details

I. General information

NPI: 1487620050
Provider Name (Legal Business Name): DANA GEORGETA KERGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA GEORGETA MARINCAT M.D.

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 COMMON RD STE 280
WARREN MI
48093-6775
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 586-393-3025
  • Fax: 586-393-3008
Mailing address:
  • Phone: 947-522-1867
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301081809
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: