Healthcare Provider Details

I. General information

NPI: 1902713019
Provider Name (Legal Business Name): NOAH GAYDOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38800 GARFIELD RD STE 100
CLINTON TOWNSHIP MI
48038-6619
US

IV. Provider business mailing address

3520 RIVER OAKS BLVD APT 3110
ROCHESTER HILLS MI
48309-2799
US

V. Phone/Fax

Practice location:
  • Phone: 586-231-0306
  • Fax:
Mailing address:
  • Phone: 586-214-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: