Healthcare Provider Details

I. General information

NPI: 1831050657
Provider Name (Legal Business Name): STACIE GRYGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W LOVELL ST
KALAMAZOO MI
49007-4509
US

IV. Provider business mailing address

1380 117TH AVE
OTSEGO MI
49078-9723
US

V. Phone/Fax

Practice location:
  • Phone: 269-271-3860
  • Fax:
Mailing address:
  • Phone: 269-271-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: