Provider Demographics
NPI:1861687006
Name:MICHAEL E GRUBER MD PC
Entity type:Organization
Organization Name:MICHAEL E GRUBER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:989-892-6587
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-892-6587
Mailing Address - Fax:989-892-3140
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-892-6587
Practice Address - Fax:989-892-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z91190OtherBCBSM GROUP
MIMG036542OtherBCBSM LICENSE NUMBER
MI0Z91190OtherBCBSM GROUP
MI0P50020Medicare PIN