MEDICARE: DR. CRAIG J GORDON D.O.

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	207RH0003X	Hematology & Oncology Physician	5101008584	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137130	OTHER	MI	CARE CHOICES
2	4559260	OTHER	MI	AETNA
3	F02038	OTHER	MI	HAP
4	115532	OTHER	MI	GREAT LAKES HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1156304464	OTHER	MI	BLUE CROSS BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1659368058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG J GORDON D.O.

Provider Business Mailing Address
First Line	:	30160 ORCHARD LAKE RD
Second Line	:	STE 100
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2254
Country	:	US
Telephone Number	:	248-522-0222
Fax Number	:	248-522-0225

Provider Business Practice Location Address
First Line	:	30160 ORCHARD LAKE RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2254
Country	:	US
Telephone Number	:	248-522-0222
Fax Number	:	248-522-0225

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	10/29/2019

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