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NPI Code Detail

MEDICARE: PAUL C GRYZENIA MD

MEDICARE: PAUL C GRYZENIA MD
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
12085R0202XDiagnostic Radiology Physician205707MA
22085R0202XDiagnostic Radiology Physician4301104034MI
32085R0204XVascular & Interventional Radiology Physician1833495MI
42085R0204XVascular & Interventional Radiology Physician4301104034MI

General Provider Information

NPI Number : 1255325262
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL C GRYZENIA MD
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 07/29/2022

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