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General NPI Number Information
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NPI Number | 1750608345
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Entity Type | Organization
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Legal Business Name | JACQUELINE FABELLO-GAMIAO MD PC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 37650 PROFESSIONAL CENTER DR STUITE 100A
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City | LIVONIA
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State | MI
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Zip | 48154-1197
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Country | US
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Telephone | 734-462-1940
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Fax | 734-462-1960
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Provider Business Mailing Address
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Address Line | 37650 PROFESSIONAL CENTER DR STUITE 100A
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City | LIVONIA
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State | MI
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Zip | 48154-1197
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Country | US
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Telephone | 734-462-1940
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Fax | 734-462-1960
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JACQUELINE FABELLO-GAMIAO
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Credential | MD
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Telephone | 734-462-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 4301060039
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License Number State | MI
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