Provider Demographics
NPI:1184608457
Name:CLAGUE, GREGORY Q (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:Q
Last Name:CLAGUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2993
Mailing Address - Country:US
Mailing Address - Phone:248-544-8326
Mailing Address - Fax:248-544-2028
Practice Address - Street 1:10300 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2993
Practice Address - Country:US
Practice Address - Phone:248-544-8326
Practice Address - Fax:248-544-2028
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006602208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184608457Medicaid
MI700H217350OtherBLUE SHIELD
MI1184608457Medicaid
MI0M92440033Medicare PIN