Healthcare Provider Details

I. General information

NPI: 1134794415
Provider Name (Legal Business Name): CANDICE NOEL GARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRANK LLOYD WRIGHT DR LOBBY H SUITE 2100
ANN ARBOR MI
48105
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR LBBY H
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 303-582-4049
  • Fax:
Mailing address:
  • Phone: 734-647-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301511036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: