Provider Demographics
NPI:1063738458
Name:GERRISH, CHAD MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:GERRISH
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3811
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3811
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2014-03-06
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Provider Licenses
StateLicense IDTaxonomies
MI5101018675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063738458Medicaid