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General NPI Number Information
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NPI Number | 1790103737
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Entity Type | Individual
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Provider Name | TERRY L GARDINER M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2014
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 1500 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1849
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Country | US
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Telephone | 231-672-3027
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Fax | 231-672-3873
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Provider Business Mailing Address
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Address Line | 1221 YORKSHIRE DR APT 203
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City | NORTON SHORES
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State | MI
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Zip | 49441-5358
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Country | US
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Telephone | 231-672-3027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 4301502632
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License Number State | MI
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