Provider Demographics
NPI:1205874302
Name:GARDI, DELAIR OMAR (MD, FACC, FSCI)
Entity type:Individual
Prefix:DR
First Name:DELAIR
Middle Name:OMAR
Last Name:GARDI
Suffix:
Gender:M
Credentials:MD, FACC, FSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 724
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2014
Mailing Address - Country:US
Mailing Address - Phone:313-832-8888
Mailing Address - Fax:313-832-4988
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 724
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-832-8888
Practice Address - Fax:313-832-4988
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081084207R00000X, 207RC0000X, 207RI0011X, 207UN0901X, 2086S0129X
MO2001000662207RI0011X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205874302Medicaid
MI1205874302Medicaid
MIH88667Medicare UPIN