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General NPI Number Information
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NPI Number | 1871587493
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Entity Type | Individual
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Provider Name | HOWARD O GRUNDY MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 24 JOLIET ST
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City | DYER
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State | IN
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Zip | 46311-1705
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Country | US
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Telephone | 219-864-2036
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Fax | 219-864-2253
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Provider Business Mailing Address
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Address Line | 431 WESTMINSTER DR
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City | BURR RIDGE
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State | IL
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Zip | 60527-8338
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Country | US
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Telephone | 219-864-2107
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Fax | 219-864-2649
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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 | 01037603A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | ME159626
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License Number State | FL
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