Provider Demographics
NPI:1700964715
Name:GLORIA JUE DO PC
Entity Type:Organization
Organization Name:GLORIA JUE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-733-5090
Mailing Address - Street 1:1335 S LINDEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3420
Mailing Address - Country:US
Mailing Address - Phone:810-733-5090
Mailing Address - Fax:810-733-5093
Practice Address - Street 1:1335 S LINDEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3420
Practice Address - Country:US
Practice Address - Phone:810-733-5090
Practice Address - Fax:810-733-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGJ007218207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1J56053OtherHEALTH PLUS OF MICHIGAN
MI11184286911Medicaid
MIC5276OtherMCARE
MIE25917OtherHAP PROVIDER ID
MI1652508580OtherBLUE CARE NETWORK
MI114272OtherPREFERRED CHOICES
MI1652508580OtherBCBS
MIQMXPR00205OtherMOLINA
MI5250858OtherRAILROAD MEDICARE
MIC5276OtherMCARE
MIE25917OtherHAP PROVIDER ID
MI0P31460Medicare ID - Type Unspecified