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General NPI Number Information
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NPI Number | 1841212701
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Entity Type | Individual
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Provider Name | JAN C GROMADA DO
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 420 LAKE NEPESSING RD
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City | LAPEER
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State | MI
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Zip | 48446-2961
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Country | US
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Telephone | 810-245-9011
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Fax |
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Provider Business Mailing Address
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Address Line | 420 LAKE NEPRESSING RD
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City | LAPEER
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State | MI
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Zip | 48446
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Country | US
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Telephone | 810-245-9011
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | JG006098
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License Number State | MI
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