Provider Demographics
NPI:1457531865
Name:GRONDIN, MICHAEL THOMAS (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:GRONDIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 NORTH UNIVERSITY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-963-6500
Mailing Address - Fax:954-963-6233
Practice Address - Street 1:601 NW 179TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2819
Practice Address - Country:US
Practice Address - Phone:954-431-2122
Practice Address - Fax:954-432-9013
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2022-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9104351363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical