Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101016902 | MI |
Y | 207Q00000X | Family Doctor | 5101016902 | MI |
NPI | 1124240858 |
---|---|
Provider Name | Amber M. Gruber |
First Address | Sterling Heights, MI 48314 |
Second Address | Sterling Heights, MI 48314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 21/10/2020 |