| Gladstone A. Payton, D.o.,pc | |
|
247 Northbound Gratiot Ave Mount Clemens MI 48043-5746 | |
| (586) 468-8088 | |
| Not Available |
| Full Name | Gladstone A. Payton, D.o.,pc |
|---|---|
| Speciality | Family Medicine |
| Location | 247 Northbound Gratiot Ave, Mount Clemens, Michigan |
| Authorized Official Name and Position | Gladstone A. Payton (PRESIDENT) |
| Authorized Official Contact | 5864688088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gladstone A. Payton, D.o.,pc 247 Northbound Gratiot Ave Mount Clemens MI 48043-5746 Ph: (586) 468-8088 | Gladstone A. Payton, D.o.,pc 247 Northbound Gratiot Ave Mount Clemens MI 48043-5746 Ph: (586) 468-8088 |
| NPI Number | 1386865228 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 02/08/2008 |
| Medicare PECOS PAC ID | 6204916612 |
|---|---|
| Medicare Enrollment ID | O20080110000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386865228 | NPI | - | NPPES |
| 1003624 | Medicaid | MI | |
| 0855018335 | Other | MI | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101005762 (Michigan) | Primary |
| Provider Name | Gladstone A Payton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184617854 PECOS PAC ID: 4981518768 Enrollment ID: I20080110000147 |
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