MEDICARE: JAN C GROMADA DO

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	207V00000X	Obstetrics & Gynecology Physician	JG006098	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	114901620	OTHER	MI	MOLINA
3	141205	OTHER	MI	CARE CHOICES
4	1015855	OTHER	MI	MCLAREN HEALTH PLAN
5	1G00026	OTHER	MI	HEALTH PLAN OF MICHIGAN
6	C1522	OTHER	MI	MCARE HMO
7	1654410124	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1841212701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN C GROMADA DO

Provider Business Mailing Address
First Line	:	420 LAKE NEPRESSING RD
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446
Country	:	US
Telephone Number	:	810-245-9011
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 LAKE NEPESSING RD
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2961
Country	:	US
Telephone Number	:	810-245-9011
Fax Number	:

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	12/10/2012

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Directions to “ JAN C GROMADA DO” Practice Location

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