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General NPI Number Information
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NPI Number | 1316072531
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Entity Type | Organization
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Legal Business Name | PAUNEL GRIVEJ MD PC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 ELIZABETH LAKE ROAD
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City | WATERFORD
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State | MI
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Zip | 48328
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Country | US
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Telephone | 248-681-4300
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Fax | 248-681-9540
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Provider Business Mailing Address
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Address Line | 2801 ELIZABETH LAKE ROAD
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City | WATERFORD
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State | MI
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Zip | 48328
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Country | US
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Telephone | 248-681-4300
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Fax | 248-681-9540
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Authorized Official
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Title or Position | MD PRESIDENT
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Name | PAUNEL GRIVEJ
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Credential | MD
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Telephone | 248-681-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | PG070993
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License Number State | MI
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