Basic Information
| Provider Information | |||||||||
| NPI: | 1598858292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENTZ | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN. MS. CS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4122 SYLVAN RD. | ||||||||
| Address2: | |||||||||
| City: | GRASS LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347697100 | ||||||||
| FaxNumber: | 7347697416 | ||||||||
| Practice Location | |||||||||
| Address1: | 2215 FULLER RD. | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348453041 | ||||||||
| FaxNumber: | 7342227648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 4704170054 | MI | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 364SP0809X | 4704170054 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.