=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275623761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | J. MICHAEL GRUENWALD MD FACS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6221 COLONEL GLENN RD STE B
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72204-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-441-5558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6221 COLONEL GLENN RD STE B
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72204-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-441-5558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0801X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Trauma Physician
-----------------------------------------------------
License Number | C-8343
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------