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General NPI Number Information
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NPI Number | 1033118658
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Entity Type | Organization
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Legal Business Name | EDWARD S. GORDON DPM PC
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25656 SCHOENHERR ROAD
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City | WARREN
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State | MI
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Zip | 48089-1447
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Country | US
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Telephone | 586-779-4820
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Fax | 586-779-9535
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Provider Business Mailing Address
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Address Line | 25656 SCHOENHERR ROAD
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City | WARREN
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State | MI
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Zip | 48089-1447
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Country | US
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Telephone | 586-779-4820
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Fax | 586-779-9535
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD SERGE GORDON
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Credential | DPM
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Telephone | 586-779-4820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | EG0000597
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License Number State | MI
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