MEDICARE: MICHAEL JOHNATHAN GRUNSTED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	48140	OK

General Provider Information

NPI Number	:	1215655857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHNATHAN GRUNSTED

Provider Business Mailing Address
First Line	:	800 STANTON L YOUNG BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5018
Country	:	US
Telephone Number	:	405-271-2316
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 STANTON L YOUNG BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5036
Country	:	US
Telephone Number	:	405-271-2316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	05/25/2026

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