Healthcare Provider Details

I. General information

NPI: 1588654818
Provider Name (Legal Business Name): GREGOR M MCKENDRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30055 NORTHWESTERN HWY STE 220
FAMINGTON HILLS MI
48334
US

IV. Provider business mailing address

30055 NORTHWESTERN HWY STE 220
FAMINGTON HILLS MI
48334
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-9898
  • Fax: 248-865-9423
Mailing address:
  • Phone: 248-865-9898
  • Fax: 248-865-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301036744
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: