Provider Demographics
NPI:1124116108
Name:GRAY, NATALIE A (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7823
Mailing Address - Country:US
Mailing Address - Phone:231-935-8031
Mailing Address - Fax:231-935-8099
Practice Address - Street 1:1400 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7823
Practice Address - Country:US
Practice Address - Phone:231-935-8031
Practice Address - Fax:231-935-8099
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B86016110Medicare ID - Type UnspecifiedMEDICARE
MI0P08010003Medicare ID - Type UnspecifiedMEDICARE
MIH72158Medicare UPIN