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General NPI Number Information
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NPI Number | 1205824570
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Entity Type | Individual
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Provider Name | DAVID CHARLES GRELLMANN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 6913 N MAIN ST
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City | GRANGER
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State | IN
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Zip | 46530-9601
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Country | US
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Telephone | 574-647-1500
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Fax | 574-243-4306
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DRIVE SUITE 100
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City | GRANGER
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State | IN
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Zip | 46530-3245
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Country | US
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Telephone | 574-647-1840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01052373A
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License Number State | IN
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