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General NPI Number Information
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NPI Number | 1174784474
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Entity Type | Organization
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Legal Business Name | GERARD MAHONEY PLLC
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 210 MAPLE AVE
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City | FRANKFORT
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State | MI
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Zip | 49635-9745
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Country | US
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Telephone | 231-608-0033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1024
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City | CADILLAC
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State | MI
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Zip | 49601-6024
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Country | US
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Telephone | 231-775-6076
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Fax | 231-775-0027
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Authorized Official
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Title or Position | OWNER
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Name | GERARD MAHONEY
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Credential | D.O.
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Telephone | 231-775-6076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101012168
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License Number State | MI
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