Provider Demographics
NPI:1770274805
Name:HOOKS, GREGORY MICHAEL
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:HOOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 HOLMES AVE S APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2638
Mailing Address - Country:US
Mailing Address - Phone:952-857-9044
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE RM M136
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-4477
Practice Address - Fax:612-626-7042
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty