MEDICARE: DALE MILLER GRUNEWALD 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	207Q00000X	Family Medicine Physician	01543	IA

General Provider Information

NPI Number	:	1871595207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE MILLER GRUNEWALD D.O.

Provider Business Mailing Address
First Line	:	230 S 68TH ST
Second Line	:	SUITE 1203
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8176
Country	:	US
Telephone Number	:	515-471-1800
Fax Number	:	515-471-1801

Provider Business Practice Location Address
First Line	:	230 S 68TH ST
Second Line	:	SUITE 1203
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8176
Country	:	US
Telephone Number	:	515-471-1800
Fax Number	:	515-471-1801

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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