Provider Demographics
NPI:1912797127
Name:GALLANT, MICHAEL T
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:GALLANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SPRING ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7561
Mailing Address - Country:US
Mailing Address - Phone:207-747-7062
Mailing Address - Fax:
Practice Address - Street 1:48 SPRING ST APT 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7561
Practice Address - Country:US
Practice Address - Phone:207-747-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant