Healthcare Provider Details

I. General information

NPI: 1891755609
Provider Name (Legal Business Name): DAVID WILLIAM GELBACH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

1323 WEDGEWOOD CIR
SALINE MI
48176-9276
US

V. Phone/Fax

Practice location:
  • Phone: 743-712-3840
  • Fax:
Mailing address:
  • Phone: 734-429-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704178571
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: