Provider Demographics
NPI:1144208232
Name:FABELLO-GAMIAO, JACQUELINE F (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:F
Last Name:FABELLO-GAMIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:F
Other - Last Name:FABELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:37650 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1197
Mailing Address - Country:US
Mailing Address - Phone:734-462-1940
Mailing Address - Fax:734-462-1960
Practice Address - Street 1:37650 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1197
Practice Address - Country:US
Practice Address - Phone:734-462-1940
Practice Address - Fax:734-462-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060039207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P40000Medicare ID - Type Unspecified
I25628Medicare UPIN