Healthcare Provider Details

I. General information

NPI: 1477548741
Provider Name (Legal Business Name): PAUL GREGORY ST CLAIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 370
LANSING MI
48912-1800
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 370
LANSING MI
48912-1800
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-4451
  • Fax: 517-484-0291
Mailing address:
  • Phone: 517-484-4451
  • Fax: 517-484-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301403243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: