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Individual
DEREK WAYNE GRAMZA
Active
Individual
DEREK WAYNE GRAMZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
G652139866851
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMP107347966001
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/02/2017
Last updated
10/02/2017
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