Provider Demographics
NPI:1083721310
Name:GRUSZYNSKI, THOMAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:GRUSZYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MEMORIAL DR
Mailing Address - Street 2:SUITE 616
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-234-2128
Mailing Address - Fax:574-234-4775
Practice Address - Street 1:621 MEMORIAL DR
Practice Address - Street 2:SUITE 616
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-234-2128
Practice Address - Fax:574-234-4775
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023429A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95759Medicare UPIN
IN738050AMedicare ID - Type Unspecified