Provider Demographics
NPI:1275623761
Name:GRUENWALD, J. MICHAEL (MD FACS)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:MICHAEL
Last Name:GRUENWALD
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:DR
Other - First Name:JOHANNES
Other - Middle Name:MICHAEL
Other - Last Name:GRUENWALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:515 READ ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1739
Mailing Address - Country:US
Mailing Address - Phone:812-424-9291
Mailing Address - Fax:812-421-2722
Practice Address - Street 1:515 READ ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1739
Practice Address - Country:US
Practice Address - Phone:812-424-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8343207XX0801X
IN01072892A207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma