Healthcare Provider Details

I. General information

NPI: 1346358231
Provider Name (Legal Business Name): JOSEPH MICHAEL GRYSKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

IV. Provider business mailing address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

V. Phone/Fax

Practice location:
  • Phone: 952-435-0177
  • Fax: 952-435-6287
Mailing address:
  • Phone: 952-435-0177
  • Fax: 952-435-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number28,402
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: