Healthcare Provider Details

I. General information

NPI: 1407963234
Provider Name (Legal Business Name): GARY EDWARD HOSEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64177 VAN DYKE RD
WASHINGTON MI
48095-2580
US

IV. Provider business mailing address

64177 VAN DYKE RD
WASHINGTON MI
48095-2580
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-5770
  • Fax: 586-752-5771
Mailing address:
  • Phone: 810-329-0800
  • Fax: 810-329-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001469
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: