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NPI Code Detail

MEDICARE: SHELLY L GRUENBACHER MD

MEDICARE: SHELLY L GRUENBACHER 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
1207Q00000XFamily Medicine Physician28950KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080188021OTHERKSTRAVELERS MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3102121OTHERKSBCBS

General Provider Information

NPI Number : 1811941347
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY L GRUENBACHER MD
Provider Business Mailing Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-3333
Fax Number : 785-754-2335
Provider Business Practice Location Address
First Line : 501 GARFIELD ST
Second Line :
City : QUINTER
State : KS
Zip : 67752-9795
Country : US
Telephone Number : 785-754-3333
Fax Number : 785-754-2335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 12/22/2011

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