MEDICARE: GAIL KING R.D.

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
1	133V00000X	Registered Dietitian	800034	MI

General Provider Information

NPI Number	:	1306172523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL KING R.D.

Provider Business Mailing Address
First Line	:	13183 BACKUS ST
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-1147
Country	:	US
Telephone Number	:	734-444-6720
Fax Number	:	313-284-7422

Provider Business Practice Location Address
First Line	:	1420 WASHINGTON BLVD STE 301
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1718
Country	:	US
Telephone Number	:	734-444-6720
Fax Number	:	313-284-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/19/2021

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Directions to “ GAIL KING R.D.” Practice Location

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