MEDICARE: DR. IRVIN J. GASTMAN DO, PHD

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	2083P0901X	Public Health & General Preventive Medicine Physician	5101007321	MI
2	207Q00000X	Family Medicine Physician	IG007321	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942263843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRVIN J. GASTMAN DO, PHD

Provider Business Mailing Address
First Line	:	18000 W 9 MILE RD STE 200
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4020
Country	:	US
Telephone Number	:	248-336-4000
Fax Number	:	248-336-9137

Provider Business Practice Location Address
First Line	:	20901 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1904
Country	:	US
Telephone Number	:	313-564-5510
Fax Number	:	248-336-9137

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	12/16/2025

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