Provider Demographics
NPI:1144631516
Name:GERGIS, CANDICE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:GERGIS
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 WINDHAM HILL CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2755
Mailing Address - Country:US
Mailing Address - Phone:248-892-1707
Mailing Address - Fax:
Practice Address - Street 1:5313 WINDHAM HILL CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2755
Practice Address - Country:US
Practice Address - Phone:248-892-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant