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General NPI Number Information
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NPI Number | 1639381460
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Entity Type | Organization
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Legal Business Name | GULL CROSSING FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 3048 W MAIN ST
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City | KALAMAZOO
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State | MI
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Zip | 49006-2956
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Country | US
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Telephone | 269-385-2784
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Fax | 269-385-2321
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Provider Business Mailing Address
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Address Line | PO BOX 2588
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City | PORTAGE
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State | MI
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Zip | 49081-2588
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Country | US
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Telephone | 269-385-2784
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Fax | 269-385-2321
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEOFFREY KAY HAMMOND
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Credential | M.D.
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Telephone | 269-385-2784
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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 | 4301035723
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License Number State | MI
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