Individual
CRYSTAL RENEE GARDNER-MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18302 MIDDLEBELT RD, LIVONIA, MI 48152-5007
(248) 478-1500
(248) 478-2798
Mailing address
18302 MIDDLEBELT RD, LIVONIA, MI 48152-5007
(248) 478-1500
(248) 478-2798
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301073171
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-42053230
—
MI
01
—
11276684
CAQH
—
05
—
1447244280
—
MI
Enumeration date
09/08/2005
Last updated
09/09/2022
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