1386178457 NPI number — HESHAM GAYAR, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386178457 NPI number — HESHAM GAYAR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HESHAM 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:
1386178457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 BEECHER RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-342-3813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 SOUTH DR
Provider Second Line Business Practice Location Address:
MOREY CANCER CENTER RADIATION DEPT
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-772-6811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2017

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)