Healthcare Provider Details

I. General information

NPI: 1417176025
Provider Name (Legal Business Name): DO GARDI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST SUITE 724
DETROIT MI
48201-2020
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 724
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-8888
  • Fax: 313-832-4988
Mailing address:
  • Phone: 313-832-8888
  • Fax: 313-832-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301081084
License Number StateMI

VIII. Authorized Official

Name: DR. DELAIR OMAR GARDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-832-8888