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1730188640

NPI Code Detail

MEDICARE: MICHAEL L GREGG MD

MEDICARE: MICHAEL L GREGG MD

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	2085R0202X	Diagnostic Radiology Physician	35061759	OH
2	208D00000X	General Practice Physician	35061759	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730188640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L GREGG MD

Provider Business Mailing Address
First Line	:	4055 VALLEY VIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 VALLEY VIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5074
Country	:	US
Telephone Number	:	972-715-3800
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/17/2015

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Directions to “ MICHAEL L GREGG MD” Practice Location

Language	Start Address	Practice Location

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