Healthcare Provider Details

I. General information

NPI: 1477517191
Provider Name (Legal Business Name): JOHN GRABOWSKI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

PO BOX 361038
GROSSE POINTE FARMS MI
48236-5038
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-4906
  • Fax: 313-576-1091
Mailing address:
  • Phone: 586-582-7979
  • Fax: 586-582-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301048493
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301048493
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: