Provider Demographics
NPI:1275672420
Name:STEVENS, GREGORY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GEORGE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 CROSS CREEK PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2774
Mailing Address - Country:US
Mailing Address - Phone:248-377-0600
Mailing Address - Fax:248-377-0606
Practice Address - Street 1:3100 CROSS CREEK PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2774
Practice Address - Country:US
Practice Address - Phone:248-377-0600
Practice Address - Fax:248-377-0606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC2481OtherMCARE
MA0634200OtherBLUE CROSS BLUE SHIELD
MI2383024OtherCIGNA
MI4305665OtherAETNA
MIC2481OtherMCARE
MI2383024OtherCIGNA