Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101016401 | MI |
N | 207Q00000X | Family Doctor | 5101016401 | MI |
NPI | 1437371788 |
---|---|
Provider Name | Darren Lloyd Grunwaldt |
First Address | Muskegon, MI 49444-1886 |
Second Address | Wyoming, MI 49548-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 31/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0D16299078 | (02) | MI |
OE06239098 | MEDICARE (01) | MI |