Provider Demographics
NPI:1215154497
Name:GRUNBERGER DIABETES MEDICAL CENTER, PC
Entity type:Organization
Organization Name:GRUNBERGER DIABETES MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-335-7740
Mailing Address - Street 1:43494 WOODWARD AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5052
Mailing Address - Country:US
Mailing Address - Phone:248-335-7740
Mailing Address - Fax:248-338-7979
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5052
Practice Address - Country:US
Practice Address - Phone:248-335-7740
Practice Address - Fax:248-338-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049764207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N50760Medicare ID - Type Unspecified