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CHARLES MICHAEL GRUDEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3200 SW 34TH AVE, SUITE 502, OCALA, FL 34474-7456
(352) 629-7011
(352) 629-7924
Mailing address
3200 SW 34TH AVE, SUITE 502, OCALA, FL 34474-7456
(352) 629-7011
(352) 629-7924

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
ME 61060
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17875
BCBS
01
720000084
RAILROAD MEDICARE
FL
Enumeration date
08/30/2006
Last updated
06/27/2008
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