Provider Demographics
NPI:1598226029
Name:GRAY, ALICIA PAULETTE (DO)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:PAULETTE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD WYANDOTTE HOSPTIAL, MEDICAL EDUCATION
Mailing Address - Street 2:2333 BIDDLE AVE
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192
Mailing Address - Country:US
Mailing Address - Phone:734-246-8004
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD WYANDOTTE HOSPTIAL, MEDICAL EDUCATION
Practice Address - Street 2:2333 BIDDLE AVE
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-246-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
MI5151013576207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program