Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301101049 | MI |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301101049 | MI |
NPI | 1033471859 |
---|---|
Provider Name | Stephen Michael Gorga |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 10/07/2019 |