Provider Demographics
NPI:1639623861
Name:SHIRES, GARETH
Entity Type:Individual
Prefix:MR
First Name:GARETH
Middle Name:
Last Name:SHIRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36630 JEFFERSON CT APT 7303
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1951
Mailing Address - Country:US
Mailing Address - Phone:248-408-3061
Mailing Address - Fax:
Practice Address - Street 1:36630 JEFFERSON CT APT 7303
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-1951
Practice Address - Country:US
Practice Address - Phone:248-408-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other