Healthcare Provider Details

I. General information

NPI: 1184608457
Provider Name (Legal Business Name): GREGORY Q. CLAGUE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W 9 MILE RD
OAK PARK MI
48237-2993
US

IV. Provider business mailing address

10300 W 9 MILE RD
OAK PARK MI
48237-2993
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-8326
  • Fax: 248-544-2028
Mailing address:
  • Phone: 248-544-8326
  • Fax: 248-544-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101006602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: