Basic Information
| Provider Information | |||||||||
| NPI: | 1265473680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENDRESBERCHER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 GREEN RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349953764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 104 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486171409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893869951 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 01/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 060087 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3492714 | 05 | MI | MEDICAID | 3492699 | 05 | MI | MEDICAID | 3495770 | 05 | MI | MEDICAID | GE060087 | 01 | MI | BC/BS | OTHER | 3495761 | 05 | MI | MEDICAID | 3505821 | 05 | MI | MEDICAID |