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Individual

MARK A GARDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2845 GREENBRIER RD STE 330, GREEN BAY, WI 54311-6519
(920) 288-8350
(920) 288-8355
Mailing address
2845 GREENBRIER RD STE 330, PO BOX 8900, GREEN BAY, WI 54308-8900
(920) 288-8350
(920) 288-8355

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
32288
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104405670
MI
05
104584884
MI
05
104806220
MI
01
140007796
RAILROAD
WI
05
34201700
WI
Enumeration date
06/28/2006
Last updated
05/10/2021
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