Provider Demographics
NPI:1417176025
Name:DO GARDI MD PC
Entity Type:Organization
Organization Name:DO GARDI MD PC
Other - Org Name:HEART & VASCULAR CONSULTANTS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELAIR
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:GARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-832-8888
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 724
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-832-8888
Mailing Address - Fax:313-832-4988
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 724
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-832-8888
Practice Address - Fax:313-832-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0000X, 207UN0901X, 2085R0204X, 2085U0001X, 2086S0129X
MI4301081084207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4527180-10Medicaid
MI4527180-10Medicaid
MIH88667Medicare UPIN