Provider Demographics
NPI:1548347453
Name:JAMES A GELS MD PC
Entity type:Organization
Organization Name:JAMES A GELS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-547-4439
Mailing Address - Street 1:14730 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1939
Mailing Address - Country:US
Mailing Address - Phone:231-547-4439
Mailing Address - Fax:231-547-0069
Practice Address - Street 1:14730 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1939
Practice Address - Country:US
Practice Address - Phone:231-547-4439
Practice Address - Fax:231-547-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1081827Medicaid
MI0A51028OtherBCBSM PIN
DN2802OtherMEDICARE ID TYPE UNSPECIFIED
1101505440OtherBLUE CROSS BLUE SHIELD MI
MI0A51028OtherBCBSM PIN
MI1081827Medicaid