Healthcare Provider Details

I. General information

NPI: 1093834772
Provider Name (Legal Business Name): DEAN GRACE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 E MICHIGAN AVE
LANSING MI
48912-1809
US

IV. Provider business mailing address

1004 E MICHIGAN AVE
LANSING MI
48912-1809
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-3900
  • Fax:
Mailing address:
  • Phone: 517-364-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number5101011864
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: