MEDICARE: DR. ANDREW GRUENZEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	390200000X	Student in an Organized Health Care Education/Training Program		MA
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.145712	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548793177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW GRUENZEL MD

Provider Business Mailing Address
First Line	:	2687 EDGEHILL RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2805
Country	:	US
Telephone Number	:	937-430-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 SOM CENTER RD #202
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094
Country	:	US
Telephone Number	:	440-953-5760
Fax Number	:	440-953-5761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	06/29/2022

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