Basic Information
| Provider Information | |||||||||
| NPI: | 1629243613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATTO | ||||||||
| FirstName: | BLAISE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1239 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480991239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488246600 | ||||||||
| FaxNumber: | 8556186655 | ||||||||
| Practice Location | |||||||||
| Address1: | 3033 KETTERING BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932133 | ||||||||
| FaxNumber: | 9372932161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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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 | 207Q00000X | 34.008828 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.