Provider Demographics
NPI:1073522512
Name:GARDINER, JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:GARDINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W LAKE LANSING RD
Mailing Address - Street 2:FAMILY HEALTH CENTER
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1387
Mailing Address - Country:US
Mailing Address - Phone:517-336-5600
Mailing Address - Fax:
Practice Address - Street 1:1525 W LAKE LANSING RD
Practice Address - Street 2:FAMILY HEALTH CENTER
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1387
Practice Address - Country:US
Practice Address - Phone:517-336-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB49374Medicare UPIN