Provider Demographics
NPI:1275915035
Name:NEWMAN, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28300 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3704
Mailing Address - Country:US
Mailing Address - Phone:248-702-0610
Mailing Address - Fax:248-702-0613
Practice Address - Street 1:28300 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 233
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3704
Practice Address - Country:US
Practice Address - Phone:248-702-0610
Practice Address - Fax:248-702-0613
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL810583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316116858Medicaid
MI6212440001Medicare PIN