Provider Demographics
NPI:1396970687
Name:GRUNDMAN, DAVID PATRICK
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:GRUNDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2703
Mailing Address - Country:US
Mailing Address - Phone:763-232-5479
Mailing Address - Fax:
Practice Address - Street 1:5354 PARKDALE DR STE 375
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1612
Practice Address - Country:US
Practice Address - Phone:952-224-0399
Practice Address - Fax:952-224-0396
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist