Provider Demographics
NPI:1225376155
Name:THOMAS G GAZDECKI, DO, PC
Entity Type:Organization
Organization Name:THOMAS G GAZDECKI, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GADECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-692-9095
Mailing Address - Street 1:2128 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5470
Mailing Address - Country:US
Mailing Address - Phone:734-692-9095
Mailing Address - Fax:734-692-9103
Practice Address - Street 1:2128 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-5470
Practice Address - Country:US
Practice Address - Phone:734-692-9095
Practice Address - Fax:734-692-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008577208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3230686 11Medicaid
MI3230686 11Medicaid