Healthcare Provider Details

I. General information

NPI: 1386604460
Provider Name (Legal Business Name): MELISSA JANE GREGORY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN CHILDREN'S HOSPITAL OF MI
DETROIT MI
48201
US

IV. Provider business mailing address

4201 ST. ANTIONE UHC 6F MAILBOX# 226 UNIVERSITY PEDIATRICIANS
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5604
  • Fax: 313-966-0039
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301053235
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number4301053235
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: