Provider Demographics
NPI:1922016385
Name:FERGUSON, GARY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28815 8 MILE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2052
Mailing Address - Country:US
Mailing Address - Phone:248-478-6806
Mailing Address - Fax:248-478-6908
Practice Address - Street 1:28815 8 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2052
Practice Address - Country:US
Practice Address - Phone:248-478-6806
Practice Address - Fax:248-478-6908
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066797207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4375937-10Medicaid
D43120Medicare UPIN