Provider Demographics
NPI:1598735557
Name:MONROE, GREGORY (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MONROE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35150 NANKIN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2091
Mailing Address - Country:US
Mailing Address - Phone:734-513-1200
Mailing Address - Fax:734-513-1201
Practice Address - Street 1:35150 NANKIN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2091
Practice Address - Country:US
Practice Address - Phone:734-513-1200
Practice Address - Fax:734-513-1201
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4423060Medicaid
E37409Medicare UPIN