Provider Demographics
NPI:1699903716
Name:GARY, MONICA LANE (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:LANE
Last Name:GARY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:555 MIDTOWNE ST NE
Mailing Address - Street 2:STE 400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5731
Mailing Address - Country:US
Mailing Address - Phone:616-588-1200
Mailing Address - Fax:616-588-1219
Practice Address - Street 1:555 MIDTOWNE ST NE
Practice Address - Street 2:SUITE 400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5729
Practice Address - Country:US
Practice Address - Phone:616-588-1200
Practice Address - Fax:616-588-1219
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2018-01-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301094699207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP53200028Medicare PIN