Provider Demographics
NPI:1659651651
Name:GRABELL, ADAM (MA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GRABELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CHURCH ST STE 1465
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1043
Mailing Address - Country:US
Mailing Address - Phone:734-764-9466
Mailing Address - Fax:734-647-1051
Practice Address - Street 1:530 CHURCH ST STE 1465
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1043
Practice Address - Country:US
Practice Address - Phone:734-764-9466
Practice Address - Fax:734-647-1051
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014866390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program