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General NPI Number Information
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NPI Number | 1528031382
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Entity Type | Individual
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Provider Name | GARY L GRAMMENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 701 25TH AVE S SUITE # 505
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1513
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Country | US
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Telephone | 612-455-2050
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Fax | 612-455-2009
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Provider Business Mailing Address
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Address Line | 9324 WYOMING AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1436
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Country | US
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Telephone | 952-944-1745
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 22088
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License Number State | MN
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