Provider Demographics
NPI:1043549710
Name:GREGORIO IMPERIAL, MD PC
Entity type:Organization
Organization Name:GREGORIO IMPERIAL, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:IMPERIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-0020
Mailing Address - Street 1:2239 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5412
Mailing Address - Country:US
Mailing Address - Phone:810-732-0020
Mailing Address - Fax:810-732-7937
Practice Address - Street 1:2239 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5412
Practice Address - Country:US
Practice Address - Phone:810-732-0020
Practice Address - Fax:810-732-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0251754OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIB48285Medicare UPIN
MI0N10780Medicare PIN