MEDICARE: THOMAS A. GRUHLKE M.D.

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	207R00000X	Internal Medicine Physician	A90027	CA

General Provider Information

NPI Number	:	1437132438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A. GRUHLKE M.D.

Provider Business Mailing Address
First Line	:	4570 VAN NUYS BLVD
Second Line	:	PO BOX 241
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2913
Country	:	US
Telephone Number	:	818-571-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 DE SOTO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6701
Country	:	US
Telephone Number	:	888-515-3500
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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