Healthcare Provider Details

I. General information

NPI: 1689624629
Provider Name (Legal Business Name): DIANE M GRONSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE M GRONSKI-RUPP MD

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

IV. Provider business mailing address

19875 N 51ST AVE
GLENDALE AZ
85308-5114
US

V. Phone/Fax

Practice location:
  • Phone: 623-581-8998
  • Fax: 623-581-6461
Mailing address:
  • Phone: 623-581-8998
  • Fax: 623-581-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number22538
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: