1790955045 NPI number — HESHAM E GAYAR, MD, PC

Table of content: (NPI 1790955045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790955045 NPI number — HESHAM E GAYAR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HESHAM E GAYAR, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790955045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48480-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-342-3800
Provider Business Mailing Address Fax Number:
810-342-3784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 N. SHIAWASSEE STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-723-1495
Provider Business Practice Location Address Fax Number:
810-342-3874
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KNOPP
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
810-342-3813

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301056934 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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