Doctor Name: | GERALD C PARK |
NPI Number: | 1033409511 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 5301 E Huron River Dr Ypsilanti, MI - 481971051 |
Business Phone Number: | 7347128676 |
Business Fax Number: | 7342223100 |
Mailing Address: | 24 Frank Lloyd Wright Dr, Po Box 0446 - Lobby J ANN ARBOR |
State: | MI |
Postal Code: | 481059484 |
Phone Number: | 7347476766 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2011 |
NPI Last Update Date: | 08/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |