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General NPI Number Information
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NPI Number | 1548427164
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Entity Type | Individual
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Provider Name | GERALD DANESHVAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 10005 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3221
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Country | US
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Telephone | 313-782-4098
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Fax | 313-782-4977
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Provider Business Mailing Address
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Address Line | 3425 LONE PINE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3327
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Country | US
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Telephone | 734-657-6317
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301081745
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License Number State | MI
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