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General NPI Number Information
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NPI Number | 1710002001
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Entity Type | Organization
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Legal Business Name | KRISTYN GREGORY DO PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 57327 VAN DYKE RD
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City | WASHINGTON
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State | MI
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Zip | 48094-2892
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Country | US
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Telephone | 586-203-2020
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Fax | 586-992-1210
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Provider Business Mailing Address
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Address Line | 16075 WHITE WATER DR
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City | MACOMB
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State | MI
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Zip | 48042-6183
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Country | US
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Telephone | 810-794-7750
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Fax | 810-794-7751
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Authorized Official
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Title or Position | OWNER
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Name | KRISTYN MARIE GREGORY
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Credential | DO
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Telephone | 586-203-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5101014561
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 5101014561
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License Number State | MI
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