Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301053235 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 4301053235 | MI |
NPI | 1386604460 |
---|---|
Provider Name | Melissa Jane Gregory |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4550680.10 | (05) | MI |
F93554 | (02) | MI |