Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301070008 | MI |
N | 208600000X | Surgeon | 4301070008 | MI |
N | 208200000X | Surgeon | L7591 | TX |
N | 208600000X | Surgeon | L7591 | TX |
Y | 2086S0102X | Surgical Critical Care | 4301070008 | MI |
N | 2086S0102X | Surgical Critical Care | L7591 | TX |
N | 2086S0127X | Trauma Surgeon | L7591 | TX |
NPI | 1316978877 |
---|---|
Provider Name | Gary Alec Vercruysse |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 15/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165618301 | (05) | TX |
8K1490 | BCBS (01) | TX |
I00014 | (02) | TX |
P00063023 | RAILROAD MEDICARE (01) | TX |