MEDICARE: DR. GARY J. GRONSTEDT D.O.

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	2084P0804X	Child & Adolescent Psychiatry Physician	44987	MN
2	2084P0800X	Psychiatry Physician	44987	MN

General Provider Information

NPI Number	:	1780688531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY J. GRONSTEDT D.O.

Provider Business Mailing Address
First Line	:	2301 TRANSPORTATION RD
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3464
Country	:	US
Telephone Number	:	320-441-0120
Fax Number	:	651-431-7373

Provider Business Practice Location Address
First Line	:	2301 TRANSPORTATION RD
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-3464
Country	:	US
Telephone Number	:	320-441-0120
Fax Number	:	651-431-7373

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/03/2026

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