Provider Demographics
NPI:1689794265
Name:GERBINO, THOMAS C (AUD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:GERBINO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4254
Mailing Address - Country:US
Mailing Address - Phone:734-243-0220
Mailing Address - Fax:734-243-4269
Practice Address - Street 1:2246 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4254
Practice Address - Country:US
Practice Address - Phone:734-243-0220
Practice Address - Fax:734-243-4269
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000037231H00000X, 237600000X
MI3501001546237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382270920OtherFEDERAL ID NUMBER
MI540E003140OtherBLUECROSS & BLUESHIELD
MI640E026870OtherBLUE CROSS & BLUE SHIELD
MI382270920OtherFEDERAL ID NUMBER