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General NPI Number Information
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NPI Number | 1902334584
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Entity Type | Individual
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Provider Name | MICHAEL GUMBO RN
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Gender | Male
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 127 NORTH AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-9717
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Country | US
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Telephone | 269-240-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 44695 BAYVIEW AVE APT 4304
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1592
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Country | US
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Telephone | 269-240-7881
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704273339
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License Number State | MI
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