Provider Demographics
NPI:1952729154
Name:GURARD, DORENEA
Entity Type:Individual
Prefix:
First Name:DORENEA
Middle Name:
Last Name:GURARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TOWN CTR
Mailing Address - Street 2:1900
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1135
Mailing Address - Country:US
Mailing Address - Phone:248-633-8511
Mailing Address - Fax:313-864-7701
Practice Address - Street 1:2000 TOWN CTR
Practice Address - Street 2:1900
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:248-633-8511
Practice Address - Fax:313-864-7701
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIG663149085565171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor