Provider Demographics
NPI:1265429526
Name:GARD, ELLOISE CAROL (MD)
Entity type:Individual
Prefix:MRS
First Name:ELLOISE
Middle Name:CAROL
Last Name:GARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1910
Mailing Address - Country:US
Mailing Address - Phone:419-661-4001
Mailing Address - Fax:
Practice Address - Street 1:30000 E RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3429
Practice Address - Country:US
Practice Address - Phone:419-661-4001
Practice Address - Fax:419-661-4015
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056648207R00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine