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General NPI Number Information
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NPI Number | 1619147493
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Entity Type | Organization
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Legal Business Name | JOANNE MARIE GRZESZAK DO PC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 806 ALGER ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3803
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Country | US
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Telephone | 616-452-8923
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 LEONARD ST NW SUITE 103
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City | WALKER
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State | MI
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Zip | 49534-8447
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Country | US
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Telephone | 616-453-6329
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Fax | 616-453-1725
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Authorized Official
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Title or Position | PROVIDER
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Name | JOANNE M GRZESZAK
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Credential | DO
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Telephone | 616-452-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 00714
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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