MEDICARE: GAIL F MCINTYRE M.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	207QA0000X	Adolescent Medicine (Family Medicine) Physician	4301030995	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4275999	OTHER	MI	CIGNA
2	P34737F	OTHER	MI	BLUE CARE NETWORK
3	137737	OTHER	MI	CARE CHOICES
4	07400172	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1366554891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL F MCINTYRE M.D.

Provider Business Mailing Address
First Line	:	3061 COMMERCE DR
Second Line	:	SUITE 5
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3881
Country	:	US
Telephone Number	:	810-385-6663
Fax Number	:	810-385-6322

Provider Business Practice Location Address
First Line	:	3061 COMMERCE DR
Second Line	:	SUITE 5
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3881
Country	:	US
Telephone Number	:	810-385-6663
Fax Number	:	810-385-6322

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ GAIL F MCINTYRE M.D.” Practice Location

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