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General NPI Number Information
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NPI Number | 1790876241
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Entity Type | Organization
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Legal Business Name | CAPITAL MEDICAL ASSOC. PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 5385 TERENCE CT
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2555
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Country | US
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Telephone | 248-851-2083
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Fax | 248-855-2130
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Provider Business Mailing Address
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Address Line | 5385 TERENCE CT
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2555
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Country | US
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Telephone | 248-851-2083
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Fax | 248-855-2130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERALD STUART GACH
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Credential | D.O.
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Telephone | 248-851-2083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | JG005927
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License Number State | MI
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