Individual
DR. STACEY MARIE GARDINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, DIVISION OF CARDIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6633
(414) 805-6280
Mailing address
9200 W WISCONSIN AVE, DIVISION OF CARDIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6633
(414) 805-6280
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45885-020
WI
207RC0000X
Cardiovascular Disease Physician
Primary
45886
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407930332
—
WI
Enumeration date
10/25/2006
Last updated
06/20/2012
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