Provider Demographics
NPI:1164474078
Name:KOBY, GREGORY B (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:KOBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 24 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3201
Mailing Address - Country:US
Mailing Address - Phone:586-677-3310
Mailing Address - Fax:586-677-3326
Practice Address - Street 1:8180 26 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5129
Practice Address - Country:US
Practice Address - Phone:586-677-3310
Practice Address - Fax:586-677-3326
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E020640OtherBCBS
MIOP48400001OtherMEDICARE GROUP
MI1022827OtherMHP HAN
MICD3610 POO374817OtherMETRAHEALTH
MI0E06239057Medicare ID - Type Unspecified
MIOP48400Medicare PIN
MIOP48400001OtherMEDICARE GROUP