Provider Demographics
NPI:1962446468
Name:GOULD, GREGORY E (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:GOULD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:60005 CAMPGROUND RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3445
Mailing Address - Country:US
Mailing Address - Phone:586-372-3500
Mailing Address - Fax:586-372-3503
Practice Address - Street 1:60005 CAMPGROUND RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3445
Practice Address - Country:US
Practice Address - Phone:586-372-3500
Practice Address - Fax:586-372-3503
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1156314265OtherBCBS MICHIGAN
MII469993Medicare UPIN
MI0P28280Medicare ID - Type Unspecified