Individual
DR. DOUGLAS JOSEPH GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4491 VENOY RD, WAYNE, MI 48184-2530
(734) 326-5030
Mailing address
4491 VENOY RD, WAYNE, MI 48184-2530
(734) 326-5030
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301063486
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4706118
—
MI
05
—
4706127
—
MI
Enumeration date
06/22/2006
Last updated
07/08/2007
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