Healthcare Provider Details

I. General information

NPI: 1366135121
Provider Name (Legal Business Name): GRANT MARTIN GINGERICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

33333 W 12 MILE RD
FARMINGTON HILLS MI
48334-3312
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2300
  • Fax:
Mailing address:
  • Phone: 248-536-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351051119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: