Healthcare Provider Details

I. General information

NPI: 1346244803
Provider Name (Legal Business Name): PETER F. GREGORY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17316 FARMINGTON RD
LIVONIA MI
48152-3158
US

IV. Provider business mailing address

17316 FARMINGTON RD
LIVONIA MI
48152-3158
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-7676
  • Fax: 734-261-2130
Mailing address:
  • Phone: 734-522-7676
  • Fax: 734-261-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000968
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000968
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: