Provider Demographics
NPI:1528229739
Name:GRUNER, MAXIMILIAN D
Entity Type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:D
Last Name:GRUNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1105
Mailing Address - Country:US
Mailing Address - Phone:907-561-5335
Mailing Address - Fax:907-564-7429
Practice Address - Street 1:540 W INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1105
Practice Address - Country:US
Practice Address - Phone:907-561-5335
Practice Address - Fax:907-564-7429
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator