Provider Demographics
NPI:1174508709
Name:RENARD, GARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:RENARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:555 BARCLAY CIR
Mailing Address - Street 2:STE 150
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4555
Mailing Address - Country:US
Mailing Address - Phone:248-299-5777
Mailing Address - Fax:248-299-6917
Practice Address - Street 1:555 BARCLAY CIR
Practice Address - Street 2:STE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4555
Practice Address - Country:US
Practice Address - Phone:248-299-5777
Practice Address - Fax:248-299-6917
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2102224Medicaid
A77291Medicare UPIN
MI2102224Medicaid