Provider Demographics
NPI:1770760175
Name:GREGORY HAINES MD LLC
Entity type:Organization
Organization Name:GREGORY HAINES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-299-8900
Mailing Address - Street 1:8750 TELEGRAPH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2397
Mailing Address - Country:US
Mailing Address - Phone:313-299-8900
Mailing Address - Fax:313-299-8600
Practice Address - Street 1:8750 TELEGRAPH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2397
Practice Address - Country:US
Practice Address - Phone:313-299-8900
Practice Address - Fax:313-299-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108209012OtherBLUE CROSS BLUE SHEILD