Provider Demographics
NPI:1578756060
Name:THOMAS R GRUSZYNSKI MD INC
Entity Type:Organization
Organization Name:THOMAS R GRUSZYNSKI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUSZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-234-2128
Mailing Address - Street 1:621 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 616
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-234-2128
Mailing Address - Fax:574-234-4775
Practice Address - Street 1:621 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 616
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-234-2128
Practice Address - Fax:574-234-4775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS R GRUSZYNSKI MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC1023429A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95759Medicare UPIN
738050Medicare Oscar/Certification