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General NPI Number Information
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NPI Number | 1659566057
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Entity Type | Organization
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Legal Business Name | GROSSE POINTE PHYSIATRY, PLLC
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Dates
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Enumeration Date | 09/09/2007
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 18530 MACK AVE SUITE 411
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-3254
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Country | US
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Telephone | 313-655-4824
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Fax | 313-886-3910
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Provider Business Mailing Address
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Address Line | 18530 MACK AVE SUITE 411
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-3254
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Country | US
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Telephone | 313-655-4824
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Fax | 313-886-3910
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUSAN RUTH GRABOWSKI
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Credential | D.O.
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Telephone | 313-655-4824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101014996
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License Number State | MI
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