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NPI Code Detail

MEDICARE: DR. KRISTYN MARIE GREGORY D.O.

MEDICARE: DR. KRISTYN MARIE GREGORY D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician5101014561MI
22084P0804XChild & Adolescent Psychiatry Physician5101014561MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12655012874OTHERMIBCBSM
220-8324146OTHERMITAX ID

General Provider Information

NPI Number : 1295729267
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTYN MARIE GREGORY D.O.
Provider Business Mailing Address
First Line : 2399 E WALTON BLVD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-1955
Country : US
Telephone Number : 248-475-6300
Fax Number : 248-475-6903
Provider Business Practice Location Address
First Line : 2399 E WALTON BLVD
Second Line :
City : AUBURN HILLS
State : MI
Zip : 48326-1955
Country : US
Telephone Number : 248-475-6300
Fax Number : 248-475-6402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 09/29/2025

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