Organization Name: | JOANNE MARIE GRZESZAK DO PC |
NPI Number: | 1619147493 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOANNE M GRZESZAK (PROVIDER) |
Mailing Address: | 806 Alger St Se Grand Rapids |
State: | MI US |
Postal Code: | 495073803 |
Phone Number: | 6164528923 |
Fax Number: | |
NPI Enumeration Date: | 03/07/2008 |
NPI Last Update Date: | 01/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 00714 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |