Provider Demographics
NPI:1700841228
Name:GRUNDSTEIN, MICHELE A (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:GRUNDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:GRUNDSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1261 S PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4418
Mailing Address - Country:US
Mailing Address - Phone:954-370-1900
Mailing Address - Fax:954-476-6281
Practice Address - Street 1:1261 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4418
Practice Address - Country:US
Practice Address - Phone:954-370-1900
Practice Address - Fax:954-476-6281
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260853700Medicaid
FLG92897Medicare UPIN