Provider Demographics
NPI:1619767456
Name:GRUDZIEN, MIKAELA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:NICOLE
Last Name:GRUDZIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3584
Mailing Address - Country:US
Mailing Address - Phone:248-931-4174
Mailing Address - Fax:
Practice Address - Street 1:8465 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3584
Practice Address - Country:US
Practice Address - Phone:248-931-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program