Individual
MICHAEL W GAUDERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
890 W FARIS RD, SUITE 440, GREENVILLE, SC 29605-4247
(864) 455-5125
Mailing address
7 INDEPENDENCE PT, SUITE 140, GREENVILLE, SC 29615-4566
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17609
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265047
CIGNA
SC
05
—
176099
—
SC
01
—
4007279
AETNA
SC
01
—
57-6007863046
BCBS OF SC
SC
Enumeration date
06/14/2006
Last updated
12/11/2009
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