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General NPI Number Information
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NPI Number | 1760805352
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Entity Type | Individual
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Provider Name | STEPHANIE GRONDAHL DO
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Gender | Female
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Dates
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Enumeration Date | 02/02/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1200 E MICHIGAN AVE STE 460
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City | LANSING
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State | MI
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Zip | 48912-1897
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Country | US
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Telephone | 517-364-2097
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Fax | 517-364-3336
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Provider Business Mailing Address
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Address Line | 6500 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1629
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | UO3557
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License Number State | FL
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