Individual
GREGORY PAUL DERDERIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
538 N OLD WOODWARD AVE, BIRMINGHAM, MI 48009-5375
(248) 594-3091
(248) 594-3068
Mailing address
538 N OLD WOODWARD AVE, BIRMINGHAM, MI 48009-5375
(248) 594-3091
(248) 594-3068
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
5101007182
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4406461
—
MI
Enumeration date
06/02/2005
Last updated
09/18/2012
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