Provider Demographics
NPI:1548659246
Name:MICHELLE GRUNDSTEIN M.D., LLC
Entity type:Organization
Organization Name:MICHELLE GRUNDSTEIN M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-370-1900
Mailing Address - Street 1:1261 S PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4418
Mailing Address - Country:US
Mailing Address - Phone:954-370-1900
Mailing Address - Fax:954-476-6281
Practice Address - Street 1:1261 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4418
Practice Address - Country:US
Practice Address - Phone:954-370-1900
Practice Address - Fax:954-476-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty