Provider Demographics
NPI:1164401188
Name:KARRIS, GREGORY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:KARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-1770
Mailing Address - Fax:248-443-2439
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 604
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-1770
Practice Address - Fax:248-443-2439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301029338207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
102322OtherPREFERRED CHOICES PPO
MI2105039Medicaid
C3265OtherPARTNERSHIP HEALTH
P40562OtherBLUE CARE NETWORK
C3265OtherMCARE
1006300331OtherEMPIRE BLUE CROSS
1006300331OtherBLUE TRUST
2105039OtherCOMMUNITY HEALTH
5469078OtherAETNA
MI1006300331OtherBCBS
1006300331OtherBLUE PREFERRED PLUS PPO
102322OtherCARE CHOICES
193696OtherGREAT WEST
B44389OtherALLIANCE HEALTH
06300339OtherMEDICARE RAILROAD
MIB44389OtherHAP
5469078OtherAETNA
MIB44389OtherHAP