Provider Demographics
NPI:1285672493
Name:BLIX, GREGOR W (MD)
Entity type:Individual
Prefix:DR
First Name:GREGOR
Middle Name:W
Last Name:BLIX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M206C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-488-8305
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M206
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-488-8305
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055608208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2999262-10Medicaid
MI3403905962OtherBCBS IND PIN
4348862OtherAETNA PIN
111368OtherGREAT LAKES HLTH PLN
MI340C910480OtherBCBS GRP PIN
MI2999262-10Medicaid
383148262OtherEIN-HEALTHCARE MIDWEST
E67853Medicare UPIN
MI340C910480OtherBCBS GRP PIN
111368OtherGREAT LAKES HLTH PLN