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General NPI Number Information
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NPI Number | 1376572131
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Entity Type | Individual
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Provider Name | GARY BYRON GULISH D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 3587 12TH ST
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City | WAYLAND
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State | MI
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Zip | 49348-9569
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Country | US
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Telephone | 269-792-2263
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Fax | 269-792-4344
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Provider Business Mailing Address
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Address Line | 1548 FALCON CREST DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | GG008590
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License Number State | MI
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