Provider Demographics
NPI:1275734964
Name:GRAY, MICHAEL W (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6635 DALY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3410
Mailing Address - Country:US
Mailing Address - Phone:248-538-3333
Mailing Address - Fax:248-538-3396
Practice Address - Street 1:6635 DALY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3410
Practice Address - Country:US
Practice Address - Phone:248-538-3333
Practice Address - Fax:248-538-3396
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery