Provider Demographics
NPI:1285855346
Name:GRASMAN, WENDI A (PA)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:A
Last Name:GRASMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:
Other - Last Name:GARZELONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6215 HARVEY
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9739
Mailing Address - Country:US
Mailing Address - Phone:231-799-8777
Mailing Address - Fax:231-798-7423
Practice Address - Street 1:6215 HARVEY
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-9739
Practice Address - Country:US
Practice Address - Phone:231-799-8777
Practice Address - Fax:231-798-7423
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWG004013207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION61070Medicare ID - Type Unspecified