Provider Demographics
NPI:1265622823
Name:DI GREGORIO, MICHAEL G (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:DI GREGORIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-751-6152
Mailing Address - Fax:405-475-2515
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-751-6152
Practice Address - Fax:405-752-5158
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK250213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120080AMedicaid
OK200120080AMedicaid
OK200120080AMedicaid
OK249727201Medicare PIN