Doctor Name: | MICHAEL GERSHON |
NPI Number: | 1639379381 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 125047539 |
Business Practice Address: | 27240 W Saxony Dr Channahon, IL - 604101415 |
Business Phone Number: | 8155211500 |
Business Fax Number: | 8154679801 |
Mailing Address: | 150 W High St, MORRIS |
State: | IL |
Postal Code: | 604501463 |
Phone Number: | 8159422932 |
Fax Number: | 8159423154 |
NPI Enumeration Date: | 07/20/2007 |
NPI Last Update Date: | 10/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125047539 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
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. |