Provider Demographics
NPI:1316734122
Name:WITTENBERG, GRACE FRANCES (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:FRANCES
Last Name:WITTENBERG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR.
Mailing Address - Street 2:TC 3116
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5368
Mailing Address - Country:US
Mailing Address - Phone:734-998-2020
Mailing Address - Fax:
Practice Address - Street 1:375 BRIARWOOD CIR BLDG 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1605
Practice Address - Country:US
Practice Address - Phone:734-998-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351053863390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program