MEDICARE: DR. GREGORY J MCBRIDE D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	5101018669	MI

General Provider Information

NPI Number	:	1134440845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY J MCBRIDE D.O

Provider Business Mailing Address
First Line	:	14695 PARK AVE
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1920
Country	:	US
Telephone Number	:	989-620-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	14695 PARK AVE
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1920
Country	:	US
Telephone Number	:	231-547-2812
Fax Number	:	231-547-3067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	12/23/2020

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