MEDICARE: MR. GARY A FALKENBERG DO

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	207Q00000X	Family Medicine Physician	006086	MI

General Provider Information

NPI Number	:	1336211259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY A FALKENBERG DO

Provider Business Mailing Address
First Line	:	7575 GRAND RIVER RD
Second Line	:	SUITE 209
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9309
Country	:	US
Telephone Number	:	810-844-7950
Fax Number	:	810-844-7955

Provider Business Practice Location Address
First Line	:	7575 GRAND RIVER RD
Second Line	:	SUITE 209
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9309
Country	:	US
Telephone Number	:	810-844-7950
Fax Number	:	810-844-7955

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/25/2011

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