Provider Demographics
NPI:1609061464
Name:GREGORY G NORTH PHD PC
Entity Type:Organization
Organization Name:GREGORY G NORTH PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-933-4268
Mailing Address - Street 1:5989 S SCHOMBERG RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-9703
Mailing Address - Country:US
Mailing Address - Phone:231-933-4268
Mailing Address - Fax:231-269-4461
Practice Address - Street 1:11293 N M 37
Practice Address - Street 2:SUITE A
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620-9593
Practice Address - Country:US
Practice Address - Phone:231-933-4268
Practice Address - Fax:231-269-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N80010Medicare PIN