Healthcare Provider Details

I. General information

NPI: 1396723375
Provider Name (Legal Business Name): DR. GILBERT RAOUL KLEIFF
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 ALLEN RD
WOODHAVEN MI
48183-2271
US

IV. Provider business mailing address

22150 ALLEN RD
WOODHAVEN MI
48183-2271
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-1520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: