Provider Demographics
NPI:1366554891
Name:MCINTYRE, GAIL F (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:F
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 COMMERCE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3881
Mailing Address - Country:US
Mailing Address - Phone:810-385-6663
Mailing Address - Fax:810-385-6322
Practice Address - Street 1:3061 COMMERCE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3881
Practice Address - Country:US
Practice Address - Phone:810-385-6663
Practice Address - Fax:810-385-6322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030995207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4275999OtherCIGNA
MIP34737FOtherBLUE CARE NETWORK
MI137737OtherCARE CHOICES
MI07400172OtherBCBS
MIP00062850Medicare ID - Type UnspecifiedRAILROAD
MI07400172OtherBCBS