Provider Demographics
NPI:1124080569
Name:GRUBB, MICHAEL (AUDIOLOGY DOCTORATE)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GRUBB
Suffix:
Gender:M
Credentials:AUDIOLOGY DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 BAKER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2775
Mailing Address - Country:US
Mailing Address - Phone:505-881-0202
Mailing Address - Fax:505-256-5710
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:AUDIOLOGY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:505-256-5710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2334231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist