Provider Demographics
NPI:1659566057
Name:GROSSE POINTE PHYSIATRY, PLLC
Entity Type:Organization
Organization Name:GROSSE POINTE PHYSIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GRABOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-655-4824
Mailing Address - Street 1:18530 MACK AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3254
Mailing Address - Country:US
Mailing Address - Phone:313-655-4824
Mailing Address - Fax:313-886-3910
Practice Address - Street 1:18530 MACK AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3254
Practice Address - Country:US
Practice Address - Phone:313-655-4824
Practice Address - Fax:313-886-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-09
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014996208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250H232040OtherBCBS PIN
MI0P48900Medicare PIN
MII48934Medicare UPIN
MI0P48910Medicare PIN
MI250H232040OtherBCBS PIN