Provider Demographics
NPI:1699790626
Name:MONTPETIT, GREGORY G (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:MONTPETIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25599 KELLY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4975
Mailing Address - Country:US
Mailing Address - Phone:586-445-2330
Mailing Address - Fax:586-445-2352
Practice Address - Street 1:25599 KELLY RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4975
Practice Address - Country:US
Practice Address - Phone:586-445-2330
Practice Address - Fax:586-445-2352
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIGM048923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2708570Medicaid
MIGM048923OtherSTATE LICENSE
110042849OtherRAILROAD MEDICARE
MI1105017111OtherBLUE CROSS BLUE SHIELD
MI2708570Medicaid
110042849OtherRAILROAD MEDICARE