MEDICARE: DR. FERNANDO NICOLAS GAMARRA 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
1	207RG0100X	Gastroenterology Physician	4301088745	MI

General Provider Information

NPI Number	:	1457473654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO NICOLAS GAMARRA MD

Provider Business Mailing Address
First Line	:	37399 GARFIELD RD STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3672
Country	:	US
Telephone Number	:	586-286-5400
Fax Number	:	586-576-6263

Provider Business Practice Location Address
First Line	:	37399 GARFIELD RD STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3672
Country	:	US
Telephone Number	:	586-286-5400
Fax Number	:	586-576-6263

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/21/2022

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