Provider Demographics
NPI:1568634442
Name:GRATIOT-ISABELLA NEPHROLOGY PC
Entity Type:Organization
Organization Name:GRATIOT-ISABELLA NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-463-4805
Mailing Address - Street 1:315 E WARWICK DR
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-463-4805
Mailing Address - Fax:989-463-4680
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE F-2
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-463-4805
Practice Address - Fax:989-463-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty