Provider Demographics
NPI:1396812624
Name:GROSSE PTE OBSTETRICS & GYN PC
Entity type:Organization
Organization Name:GROSSE PTE OBSTETRICS & GYN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAZYNA
Authorized Official - Middle Name:KRYSTINA
Authorized Official - Last Name:ZAJDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-882-6780
Mailing Address - Street 1:25910 KELLY RD
Mailing Address - Street 2:STE 9
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4466
Mailing Address - Country:US
Mailing Address - Phone:586-779-6222
Mailing Address - Fax:586-779-6228
Practice Address - Street 1:25910 KELLY RD
Practice Address - Street 2:STE 9
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4466
Practice Address - Country:US
Practice Address - Phone:586-779-6222
Practice Address - Fax:586-779-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGZ051612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3383620Medicaid
MIGZ051612OtherMI STATE LICENSE
MIA78218OtherHAP PROVIDER NUMBER
MI0360747OtherACOG NUMBER
MI1608250512OtherBCBS NUMBER
MI3383620Medicaid
MIE87898Medicare UPIN