Healthcare Provider Details

I. General information

NPI: 1891790804
Provider Name (Legal Business Name): GARY F GLADIEUX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 MONCLOVA RD SUITE 10
MAUMEE OH
43537-1863
US

IV. Provider business mailing address

3606 GREENLAWN CT
TOLEDO OH
43614-5119
US

V. Phone/Fax

Practice location:
  • Phone: 419-887-0803
  • Fax: 419-887-0817
Mailing address:
  • Phone: 419-385-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-05-6893-G
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.056893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: