Provider Demographics
NPI:1003820200
Name:GRUND, LYNN MAKELA (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MAKELA
Last Name:GRUND
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 1:3650 E MILLS RD
Mailing Address - Street 2:
Mailing Address - City:PICKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49774-9231
Mailing Address - Country:US
Mailing Address - Phone:480-380-6950
Mailing Address - Fax:
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-786-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079343207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003820200Medicaid
MILG079343OtherBLUE SHIELD
930117023OtherMEDICARE - MULT - RAILROAD
MI4387722Medicaid
P00365745OtherMEDICARE - MULT - RAILROAD
MILG079343OtherBLUE SHIELD
MI4387722Medicaid
MI1003820200Medicaid