1588635932 NPI number — GREGORY MICHAEL CIBOR DO

Table of content: GREGORY MICHAEL CIBOR DO (NPI 1588635932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588635932 NPI number — GREGORY MICHAEL CIBOR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIBOR
Provider First Name:
GREGORY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588635932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25925 TELEGRAPH RD
Provider Second Line Business Mailing Address:
210
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-746-0342
Provider Business Mailing Address Fax Number:
248-746-0369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30055 NORTHWESTERN HWY
Provider Second Line Business Practice Location Address:
30
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-865-4030
Provider Business Practice Location Address Fax Number:
248-865-4031
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , with the licence number:  5101013758 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 5101013758 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114842844 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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