Gwendolyn Henderson Parker, M.D.

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

4301405408 Issued in MI

Practice address

48165 Liberty Dr
Shelby TWP, MI 48315-4061

Phone

(313) 448-6780

Fax

(866) 648-5525

NPI assigned

Sep 1, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1811444235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E. LAFAYETTE BLVD",
            "address_2": "MC 504D C/O BCBSM",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482262998",
            "telephone_number": "313-448-6780",
            "fax_number": "866-648-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48165 LIBERTY DR",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483154061",
            "telephone_number": "313-448-6780",
            "fax_number": "866-648-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "GWENDOLYN",
        "middle_name": "HENDERSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301405408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiation Oncology Physician in Shelby TWP, MI
• Providers in Shelby TWP, MI by specialty
• Radiation Oncology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.