Organization
GREGORY P. DERDERIAN D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY P DERDERIAN M.D. (PRESIDEENT)
(586) 493-3175
Entity
Organization
Contact information
Practice address
6770 DIXIE HWY, 106A, CLARKSTON, MI 48346-2087
(248) 922-9371
(586) 493-3828
Mailing address
6770 DIXIE HWY, 106A, CLARKSTON, MI 48346-2087
(248) 922-9371
(586) 493-3828
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
09/25/2006
Last updated
08/22/2020
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