Provider Demographics
NPI:1881690543
Name:UITVLUGT, GREGORY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:UITVLUGT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3394 E JOLLY RD
Mailing Address - Street 2:STE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-8595
Mailing Address - Country:US
Mailing Address - Phone:517-394-3200
Mailing Address - Fax:517-394-4250
Practice Address - Street 1:3394 E JOLLY RD
Practice Address - Street 2:STE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8595
Practice Address - Country:US
Practice Address - Phone:517-394-3200
Practice Address - Fax:517-394-4250
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-12-13
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Provider Licenses
StateLicense IDTaxonomies
MI4301046327207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0331179OtherBLUECARE NETWORK
MI4385432Medicaid
MI2003311791OtherBLUE CROSS/BLUE SHIELD
MI200000001160OtherPHYSICIANS HEALTH PLAN
MI2003311791OtherBLUE CROSS/BLUE SHIELD
MI0331179OtherBLUECARE NETWORK