Provider Demographics
NPI:1912937335
Name:PUNCHES, GREGORY E (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:PUNCHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8775 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2545
Mailing Address - Country:US
Mailing Address - Phone:248-858-3051
Mailing Address - Fax:248-858-3022
Practice Address - Street 1:16100 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1148
Practice Address - Country:US
Practice Address - Phone:248-858-3051
Practice Address - Fax:248-858-3022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP077905174400000X
MI4301077905207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4814222-10Medicaid
MI4814222-10Medicaid