Healthcare Provider Details

I. General information

NPI: 1780688531
Provider Name (Legal Business Name): GARY J. GRONSTEDT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 TRANSPORTATION RD
WILLMAR MN
56201-3464
US

IV. Provider business mailing address

2301 TRANSPORTATION RD
WILLMAR MN
56201-3464
US

V. Phone/Fax

Practice location:
  • Phone: 320-441-0120
  • Fax: 651-431-7373
Mailing address:
  • Phone: 320-441-0120
  • Fax: 651-431-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number44987
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44987
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: