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NPI Code Detail

MEDICARE: MIKAELA NICOLE GRUDZIEN MD

MEDICARE: MIKAELA NICOLE GRUDZIEN 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1619767456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAELA NICOLE GRUDZIEN MD
Provider Business Mailing Address
First Line : 8465 EASTWAY DR
Second Line :
City : WHITE LAKE
State : MI
Zip : 48386-3584
Country : US
Telephone Number : 248-931-4174
Fax Number :
Provider Business Practice Location Address
First Line : 8465 EASTWAY DR
Second Line :
City : WHITE LAKE
State : MI
Zip : 48386-3584
Country : US
Telephone Number : 248-931-4174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2025
Last Update Date : 05/06/2025

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