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General NPI Number Information
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NPI Number | 1790789055
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Entity Type | Individual
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Provider Name | GINA MARIE D'AMBROSIO D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 36123 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1216
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Country | US
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Telephone | 734-464-0887
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Fax | 734-402-0254
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Provider Business Mailing Address
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Address Line | 36123 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1216
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Country | US
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Telephone | 734-793-6140
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Fax | 865-560-8948
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101014605
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 5101014605
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License Number State | MI
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