Provider Demographics
NPI:1609838804
Name:GRUBELICH, FRANCIS A (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:A
Last Name:GRUBELICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 12TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024
Mailing Address - Country:US
Mailing Address - Phone:269-375-4214
Mailing Address - Fax:269-375-4514
Practice Address - Street 1:7901 12TH ST
Practice Address - Street 2:STE 201
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-375-4214
Practice Address - Fax:269-375-4514
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI431060601207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104756924Medicaid
MI0P18670Medicare ID - Type Unspecified
MI104756924Medicaid