Healthcare Provider Details

I. General information

NPI: 1295160836
Provider Name (Legal Business Name): ADAM RUSSELL GWIZDALA DO, PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHERMAN BLVD
MUSKEGON MI
49444-1849
US

IV. Provider business mailing address

16923 PIPER WAY APT 304
GRAND HAVEN MI
49417-9075
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3937
  • Fax:
Mailing address:
  • Phone: 989-798-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151015914
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101028136
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302037090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: