Provider Demographics
NPI:1699940619
Name:KEVIN J GAFFNEY MD PC
Entity type:Organization
Organization Name:KEVIN J GAFFNEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-0001
Mailing Address - Street 1:1352 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4185
Mailing Address - Country:US
Mailing Address - Phone:810-230-0001
Mailing Address - Fax:810-230-0014
Practice Address - Street 1:1352 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4185
Practice Address - Country:US
Practice Address - Phone:810-230-0001
Practice Address - Fax:810-230-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4254753Medicaid
MI0M51430Medicare PIN
MIG35447Medicare UPIN