Provider Demographics
NPI:1790778397
Name:GRELEWICZ, JULIE M (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:GRELEWICZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 324B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-726-5075
Practice Address - Fax:231-722-1827
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1763052OtherMEDICARE PTAN
MIG56008-148Medicare PIN
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MI238599Medicare Oscar/Certification