Basic Information
| Provider Information | |||||||||
| NPI: | 1992050868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEGARA GARDEN CITY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 777307 7307 SOLUTION CENTER | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606770001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668987139 | ||||||||
| FaxNumber: | 6169759827 | ||||||||
| Practice Location | |||||||||
| Address1: | 6245 INKSTER RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481354001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344583426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | TRESSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ECO | ||||||||
| AuthorizedOfficialTelephone: | 2483385339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.