Healthcare Provider Details

I. General information

NPI: 1861615510
Provider Name (Legal Business Name): GREGORY CARDEN GIFFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SUNNYBROOK CT
SOUTH BEND IN
46637-3437
US

IV. Provider business mailing address

111 SUNNYBROOK CT. CENTER FOR HOSPICE AND PALLIATIVE CARE, INC.
SOUTH BEND IN
46637-3437
US

V. Phone/Fax

Practice location:
  • Phone: 574-243-3100
  • Fax: 574-243-3134
Mailing address:
  • Phone: 574-243-3100
  • Fax: 574-243-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01034956A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberO1O34956
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number01034956
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: