Provider Demographics
NPI:1194816835
Name:GALLARDO, MARIA GISELA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GISELA
Last Name:GALLARDO
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:OAKLAND FAMILY SERVICES
Mailing Address - Street 2:114 ORCHARD LAKE ROAD
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5641
Mailing Address - Country:US
Mailing Address - Phone:248-858-7766
Mailing Address - Fax:
Practice Address - Street 1:OAKLAND FAMILY SERVICES
Practice Address - Street 2:114 ORCHARD LAKE ROAD
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-4834
Practice Address - Country:US
Practice Address - Phone:248-858-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010674082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4658001Medicaid
MIG16004052Medicare ID - Type Unspecified
MIF94742Medicare UPIN