Provider Demographics
NPI:1912955014
Name:GORMLEY, ALLISON N (DO)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:N
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-6521
Mailing Address - Fax:989-583-4134
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-6521
Practice Address - Fax:989-583-4134
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008853207P00000X
MI5101015406207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341960760029OtherCARESOURCE
OH2724485Medicaid
MI4986343Medicaid
OH000000495818OtherANTHEM
MI4798423Medicaid
OH000000518962OtherANTHEM
OH810547599070OtherCARESOURCE
OHP00384801Medicare PIN
MI4798423Medicaid
OHAY4206401Medicare PIN
MI4986343Medicaid
OH000000495818OtherANTHEM