Provider Demographics
NPI:1417124355
Name:GARY A RENARD MD PC
Entity Type:Organization
Organization Name:GARY A RENARD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-299-5777
Mailing Address - Street 1:555 BARCLAY CIR STE 555
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4555
Mailing Address - Country:US
Mailing Address - Phone:248-299-5779
Mailing Address - Fax:248-299-6917
Practice Address - Street 1:555 BARCLAY CIR STE 555
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4555
Practice Address - Country:US
Practice Address - Phone:248-299-5779
Practice Address - Fax:248-299-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP57810Medicare PIN