Provider Demographics
NPI:1871090308
Name:GARLO, GERI LYNN (PA)
Entity type:Individual
Prefix:
First Name:GERI
Middle Name:LYNN
Last Name:GARLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13345 HAWK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1389
Mailing Address - Country:US
Mailing Address - Phone:586-634-9567
Mailing Address - Fax:
Practice Address - Street 1:35200 DEQUINDRE RD STE 600
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4841
Practice Address - Country:US
Practice Address - Phone:248-844-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001974363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical