Provider Demographics
NPI:1104031574
Name:GREN, RONALD EDMUND (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDMUND
Last Name:GREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 PIERSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2650
Mailing Address - Country:US
Mailing Address - Phone:248-349-1295
Mailing Address - Fax:248-380-1233
Practice Address - Street 1:19500 PIERSON DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2650
Practice Address - Country:US
Practice Address - Phone:248-349-1295
Practice Address - Fax:248-380-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005336204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM