Healthcare Provider Details

I. General information

NPI: 1942931456
Provider Name (Legal Business Name): GABRIELLE MARIE GUZZARDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-0161
  • Fax: 248-898-3631
Mailing address:
  • Phone: 248-898-0161
  • Fax: 248-898-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4351049959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: