Provider Demographics
NPI:1023038023
Name:GAZDECKI, THOMAS GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:GAZDECKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FORT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4636
Mailing Address - Country:US
Mailing Address - Phone:734-676-4996
Mailing Address - Fax:734-676-4407
Practice Address - Street 1:5400 FORT ST STE 200
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4636
Practice Address - Country:US
Practice Address - Phone:734-676-4996
Practice Address - Fax:734-676-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010085772086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI323068611Medicaid
MI5823799Medicare ID - Type Unspecified