Healthcare Provider Details

I. General information

NPI: 1760324982
Provider Name (Legal Business Name): MICHELE G GRONBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 COTTAGEVIEW DR STE 101
TRAVERSE CITY MI
49684-2392
US

IV. Provider business mailing address

3782 INCOCHEE RD
TRAVERSE CITY MI
49684-1410
US

V. Phone/Fax

Practice location:
  • Phone: 231-642-2778
  • Fax: 231-252-1330
Mailing address:
  • Phone: 231-590-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: