Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301040951 | MI |
NPI | 1164469680 |
---|---|
Provider Name | Bernard Gonik |
First Address | Troy, MI 48083-1189 |
Second Address | Detroit, MI 48235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 20/05/2016 |