Provider Demographics
NPI:1376508762
Name:OLDFORD, GREGORY M (MD)
Entity Type:Individual
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First Name:GREGORY
Middle Name:M
Last Name:OLDFORD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-624-9900
Practice Address - Fax:248-896-5450
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-01-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301051913208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0991057OtherHEALTH PLUS
MI340019049OtherRAILROAD MEDICARE
MI4338197OtherAETNA
MI6906739004OtherCIGNA
MI126231OtherPRIORITY HEALTH
MIF31980OtherHAP
MI0991057OtherHEALTH PLUS
MI340019049OtherRAILROAD MEDICARE
MIF31980OtherHAP