# KRISTYN GREGORY DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710002001
- **Authorized official:** KRISTYN MARIE GREGORY DO (OWNER)
- **Authorized official phone:** (586) 203-2020

## Contact information

- **Practice address:** 57327 VAN DYKE RD, WASHINGTON, MI 48094-2892
- **Practice address phone:** (586) 203-2020
- **Practice address fax:** (586) 992-1210
- **Mailing address:** 16075 WHITE WATER DR, MACOMB, MI 48042-6183
- **Mailing address phone:** (810) 794-7750
- **Mailing address fax:** (810) 794-7751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | 5101014561 | MI | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 5101014561 | MI | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2655012874 | BCBSM | MI |