Provider Demographics
NPI:1508865098
Name:GRUNDY, CYNTHIA LEMBCKE (DPM)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEMBCKE
Last Name:GRUNDY
Suffix:
Gender:
Credentials:DPM
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1101 GLENDALE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3769
Practice Address - Country:US
Practice Address - Phone:219-307-4750
Practice Address - Fax:219-307-4755
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000941A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000389506OtherANTHEM BCBS PROVIDER #
IN000000389506OtherANTHEM BCBS PROVIDER #
INU91459Medicare UPIN