Provider Demographics
NPI:1588654818
Name:MCKENDRICK, GREGOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGOR
Middle Name:M
Last Name:MCKENDRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:STE 220
Mailing Address - City:FAMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-865-9898
Mailing Address - Fax:248-865-9423
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:STE 220
Practice Address - City:FAMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-865-9898
Practice Address - Fax:248-865-9423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301036744207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45728Medicare UPIN
MIOM06660001Medicare ID - Type Unspecified