Provider Demographics
NPI:1750478012
Name:GRUNDMAN, DAVID PAUL (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:GRUNDMAN
Suffix:
Gender:M
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 404
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591
Mailing Address - Country:US
Mailing Address - Phone:812-882-3312
Mailing Address - Fax:812-882-6181
Practice Address - Street 1:902 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591
Practice Address - Country:US
Practice Address - Phone:812-882-3312
Practice Address - Fax:812-882-6181
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000497213E00000X
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
130057OtherHEALTHLINK OPEN ACESS
T35088OtherUPIN
000000085487OtherANTHEM BLUE SHIELD
000000085487OtherANTHEM BLUE SHIELD
T35088OtherUPIN
IN0936160001Medicare PIN