Provider Demographics
NPI:1578658340
Name:IMPERIAL, GREGORIO P JR (MD)
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:P
Last Name:IMPERIAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5412
Mailing Address - Country:US
Mailing Address - Phone:810-732-0020
Mailing Address - Fax:810-732-7937
Practice Address - Street 1:2239 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5412
Practice Address - Country:US
Practice Address - Phone:810-732-0020
Practice Address - Fax:810-732-7937
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0251754OtherBLUE CROSS BLUE SHIELD
MI0N10780Medicare ID - Type Unspecified
MIB48285Medicare UPIN