Basic Information
| Provider Information | |||||||||
| NPI: | 1750355640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREY | ||||||||
| FirstName: | JULIANA | ||||||||
| MiddleName: | JANICE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2249 WEALTHY ST SE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495063052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489521601 | ||||||||
| FaxNumber: | 2489521614 | ||||||||
| Practice Location | |||||||||
| Address1: | 36123 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347936140 | ||||||||
| FaxNumber: | 7344020254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301058768 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 4301058768 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.