Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036.117546 | IL |
N | 111NI0900X | Internist | 036.117546 | IL |
N | 207R00000X | Internist | 4301098017 | MI |
N | 111NI0900X | Internist | 4301098017 | MI |
Y | 207RI0200X | Infectious Disease | 4301098017 | MI |
NPI | 1013105220 |
---|---|
Provider Name | Dr. Kevin Sellery Gregg |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 26/08/2011 |