Provider Demographics
NPI:1407583933
Name:GERKMAN, DAMIAN ALOYSIUS (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:ALOYSIUS
Last Name:GERKMAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23700 ORCHARD LAKE RD STE M
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2559
Mailing Address - Country:US
Mailing Address - Phone:248-482-6222
Mailing Address - Fax:
Practice Address - Street 1:10300 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3628
Practice Address - Country:US
Practice Address - Phone:323-564-4331
Practice Address - Fax:323-564-9865
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5315235351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315235351OtherMICHIGAN STATE LICENSE
CAPA64311OtherCALIFORNIA STATE LICENSE