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NPI Code Detail

MEDICARE: TRESSA K GARDNER DO

MEDICARE:   TRESSA K GARDNER  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician5101012299MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306821756
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRESSA K GARDNER DO
Provider Business Mailing Address
First Line : 50 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48342-2217
Country : US
Telephone Number : 248-338-5327
Fax Number : 248-338-5129
Provider Business Practice Location Address
First Line : 50 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48342-2217
Country : US
Telephone Number : 248-338-5327
Fax Number : 248-338-5129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 06/02/2009

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Directions to “ TRESSA K GARDNER DO” Practice Location

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