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NPI Code Detail

MEDICARE: GERARD M MOSBY MD

MEDICARE: GERARD M MOSBY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4301051836MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013908532
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERARD M MOSBY MD
Provider Business Mailing Address
First Line : DEPT 999360 PO BOX 33738
Second Line :
City : DETROIT
State : MI
Zip : 48232-3738
Country : US
Telephone Number : 810-720-5715
Fax Number : 810-732-0891
Provider Business Practice Location Address
First Line : 10201 E JEFFERSON AVE
Second Line : SUITE 201A
City : DETROIT
State : MI
Zip : 48214-3149
Country : US
Telephone Number : 313-821-3777
Fax Number : 313-824-3777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/10/2015

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