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General NPI Number Information
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NPI Number | 1194906008
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Entity Type | Organization
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Legal Business Name | GARY T. FERGUSON, M.D., P.C.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 28815 8 MILE RD SUITE 103
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City | LIVONIA
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State | MI
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Zip | 48152-2052
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Country | US
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Telephone | 248-478-6806
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Fax | 248-478-6908
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Provider Business Mailing Address
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Address Line | 28815 8 MILE RD SUITE 103
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City | LIVONIA
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State | MI
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Zip | 48152-2052
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Country | US
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Telephone | 248-478-6806
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Fax | 248-478-6908
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Authorized Official
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Title or Position | OWNER
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Name | GARY THOMAS FERGUSON
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Credential | M.D.
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Telephone | 248-478-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4301066797
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License Number State | MI
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