GREGORY P. DERDERIAN D.O. P.C. NPI 1922108240

NPI Information

NPI: 1922108240
Provider Name: GREGORY P. DERDERIAN D.O., P.C.
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
6770 DIXIE HWY
106A
CLARKSTON, MI
ZIP 48346
Phone: (248) 922-9371
Get Directions

GREGORY P. DERDERIAN D.O., P.C. is a vascular surgery surgery in Clarkston, MI. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. GREGORY P. DERDERIAN D.O., P.C. NPI is 1922108240. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6770 DIXIE HWY
106A
CLARKSTON, MI
ZIP 48346-087
Phone: (248) 922-9371
Fax: (586) 493-3828

The provider's authorized official is Gregory P Derderian .
The authorized official title is Presideent and has the following contact phone number (586) 493-3175.

The enumeration date for this NPI number is 9/25/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	5101007182	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4406461	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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