Provider Demographics
NPI:1982776498
Name:GREENSLAIT, MICHAEL W (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GREENSLAIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-0960
Mailing Address - Country:US
Mailing Address - Phone:231-480-4668
Mailing Address - Fax:231-480-4736
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMG011039207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
050054748OtherRAILROAD MEDICARE
MI3381279Medicaid
MI0555300144OtherBLUE CROSS BLUE SHIELD
MIM43220038Medicare PIN
MI0555300144OtherBLUE CROSS BLUE SHIELD