Provider Demographics
NPI:1144324633
Name:GRAMBAU, GEOFFREY RICHES (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:RICHES
Last Name:GRAMBAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M401
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-388-5864
Mailing Address - Fax:269-388-5211
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-401
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5342
Practice Address - Country:US
Practice Address - Phone:269-388-5864
Practice Address - Fax:269-388-5211
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIGG035172207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386427Medicaid
4809117OtherPHP
MI290C96034OtherBC/BS OF MICHIGAN
290C913410OtherBCBS GRP PIN
MI290009377OtherRAILROAD MEDICARE
290394238OtherBCBS IND PIN
4379439OtherAETNA
MI4830052OtherPHP
MIP64591OtherBLUECARE NETWORK
114393OtherGRT LKS HLTH PLAN
MI382356205107OtherCOMMUNITY CHOICE OF MICH
MI0C97625097Medicare ID - Type Unspecified
MI0C96034004Medicare ID - Type Unspecified
114393OtherGRT LKS HLTH PLAN