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General NPI Number Information
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NPI Number | 1942263843
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Entity Type | Individual
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Provider Name | IRVIN J. GASTMAN DO, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 09/27/2025
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Provider Practice Location Address
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Address Line | 20901 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1904
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Country | US
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Telephone | 313-564-5510
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Fax | 248-336-9137
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Provider Business Mailing Address
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Address Line | 25241 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1404
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Country | US
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Telephone | 313-538-3800
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Fax | 313-538-3800
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 5101007321
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | IG007321
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License Number State | MI
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