Provider Demographics
NPI:1447914205
Name:GAKSTATTER, DAVID JOHN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:GAKSTATTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23535 ARMADA CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23535 ARMADA CENTER RD
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-2702
Practice Address - Country:US
Practice Address - Phone:313-402-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95250777163W00000X
WARN61054269163W00000X
SDR052136163W00000X
NY801072163W00000X
OR201704150RN163W00000X
NM56853163W00000X
IL041485412163W00000X
NV837256163W00000X
MI4704317619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse