Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 049057 | MI |
NPI | 1053300509 |
---|---|
Provider Name | Dr. Gregory W Kulesza |
First Address | Troy, MI 48084-5435 |
Second Address | Troy, MI 48084-5435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2932192 | (05) | MI |
A79272 | (02) |