Provider Demographics
NPI:1760708549
Name:MICHELE A. GARDNER, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:MICHELE A. GARDNER, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-266-0199
Mailing Address - Street 1:1542 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1392
Mailing Address - Country:US
Mailing Address - Phone:517-266-0199
Mailing Address - Fax:517-266-0196
Practice Address - Street 1:1542 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1392
Practice Address - Country:US
Practice Address - Phone:517-266-0199
Practice Address - Fax:517-266-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty