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General NPI Number Information
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NPI Number | 1922016385
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Entity Type | Individual
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Provider Name | GARY THOMAS FERGUSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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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 |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301066797
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 4301066797
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License Number State | MI
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Taxonomy #3
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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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