Provider Demographics
NPI:1053300509
Name:KULESZA, GREGORY W (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:KULESZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:264 W MAPLE RD
Mailing Address - Street 2:#200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5435
Mailing Address - Country:US
Mailing Address - Phone:248-273-9930
Mailing Address - Fax:248-273-9931
Practice Address - Street 1:264 W MAPLE RD
Practice Address - Street 2:#200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5435
Practice Address - Country:US
Practice Address - Phone:248-273-9930
Practice Address - Fax:248-273-9931
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI049057207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2932192Medicaid
MI0410030001Medicare ID - Type Unspecified
MI2932192Medicaid
MI0M10030Medicare PIN