Provider Demographics
NPI:1154989861
Name:GRIESE, KATHERINE PAIGE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PAIGE
Last Name:GRIESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:248-299-6917
Practice Address - Street 1:555 BARCLAY CIR STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4587
Practice Address - Country:US
Practice Address - Phone:248-299-5777
Practice Address - Fax:248-299-6917
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301507305207R00000X
MI4351044300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine