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NPI Code Detail

MEDICARE: BRETT L GARDNER M.D.

MEDICARE: BRETT L GARDNER M.D.
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
1207L00000XAnesthesiology Physician21688WI

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 : 1952303828
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRETT L GARDNER M.D.
Provider Business Mailing Address
First Line : 2107 HEIGHTS DR
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-6130
Country : US
Telephone Number : 715-834-8721
Fax Number : 715-834-3087
Provider Business Practice Location Address
First Line : 1221 WHIPPLE ST
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54703-5270
Country : US
Telephone Number : 715-838-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 02/05/2014

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