Healthcare Provider Details

I. General information

NPI: 1114488590
Provider Name (Legal Business Name): GONG HE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 ELLIOTT DR STE 210
YPSILANTI MI
48197-8632
US

IV. Provider business mailing address

5303 ELLIOTT DR STE 210
YPSILANTI MI
48197-8632
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-1000
  • Fax:
Mailing address:
  • Phone: 734-712-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301508743
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number127.074613
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: