Provider Demographics
NPI:1437371788
Name:GRUNWALDT, DARREN LLOYD (DO)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:LLOYD
Last Name:GRUNWALDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 E SHERMAN BLVD
Mailing Address - Street 2:STE 2400
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1886
Mailing Address - Country:US
Mailing Address - Phone:231-672-6336
Mailing Address - Fax:
Practice Address - Street 1:781 36TH ST SE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-2319
Practice Address - Country:US
Practice Address - Phone:616-252-4100
Practice Address - Fax:616-252-4953
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016401207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE06239098OtherMEDICARE
MI0D16299078Medicare UPIN