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General NPI Number Information
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NPI Number | 1952392896
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Entity Type | Organization
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Legal Business Name | CRAIG J GORDON, D.O., P.C.
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 30160 ORCHARD LAKE RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2254
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Country | US
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Telephone | 248-522-0222
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Fax | 248-522-0225
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Provider Business Mailing Address
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Address Line | 30160 ORCHARD LAKE RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2254
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Country | US
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Telephone | 248-522-0222
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Fax | 248-522-0225
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SUE HUDEL
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Credential |
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Telephone | 248-522-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | CG008584
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | SS065453
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License Number State | MI
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