Healthcare Provider Details

I. General information

NPI: 1386601367
Provider Name (Legal Business Name): MICHAEL GRUTTADAURIA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LONG POND RD SUITE 130
ROCHESTER NY
14626-5002
US

IV. Provider business mailing address

3400 AUTUMN WOOD DR
MACEDON NY
14502-8700
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-3630
  • Fax:
Mailing address:
  • Phone: 315-538-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number6156
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: