Basic Information
| Provider Information | |||||||||
| NPI: | 1962626671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARTZ | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 44TH ST SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495094313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162498000 | ||||||||
| FaxNumber: | 2159234532 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 44TH ST SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495094313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162498000 | ||||||||
| FaxNumber: | 2159234532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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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 | 207Y00000X | MD422413 | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0901X | 4301087787 | MI | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | 207Y00000X | 4301087787 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 102169271 | 05 | PA | MEDICAID | 0165662 | 05 | NJ | MEDICAID |