Gibson Fountain, Cheryl

Gibson Fountain, Cheryl is an individual health care provider with primary practice located at 15050 E Jefferson Ave , Grosse Pointe Park MI 48230-2050. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Gibson Fountain, Cheryl can be contacted via phone (313) 823-4682.

Contact Information

Primary practice address
15050 E Jefferson Ave Grosse Pointe Park MI 48230-2050
Phone: (313) 823-4682
Fax: (313) 823-8022
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 4301052473 Michigan

Profile Details

NPI number 1184612574
LBN Legal business name Gibson Fountain, Cheryl
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2005
Last updated Oct 22nd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184612574 NPPES
Michigan Other 700H249730 BCBS GROUP NUMBER
Michigan MEDICAID 4502234 BCBS GROUP NUMBER
Michigan MEDICAID 4417616 BCBS GROUP NUMBER

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