MEDICARE: DR. MICHAEL GRUTTADAURIA DPM

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	213ES0131X	Foot Surgery Podiatrist	6156	NY
2	213ES0131X	Foot Surgery Podiatrist	006156	NY

General Provider Information

NPI Number	:	1386601367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GRUTTADAURIA DPM

Provider Business Mailing Address
First Line	:	3400 AUTUMN WOOD DR
Second Line	:
City	:	MACEDON
State	:	NY
Zip	:	14502-8700
Country	:	US
Telephone Number	:	315-538-8405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 LONG POND RD
Second Line	:	SUITE 130
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5002
Country	:	US
Telephone Number	:	585-723-3630
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	06/29/2023

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