Individual
GRANT MICHAEL WALLENFELSZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
BLDG #50 FARENHOLT AVE, AGANA HEIGHTS, GU 96910
(671) 344-9340
Mailing address
PSC 455 BOX 208, FPO, AP 96540-0003
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
A187218
CA
207P00000X
Emergency Medicine Physician
M-2480
GU
207P00000X
Emergency Medicine Physician
Primary
T3715
TX
Other
Enumeration date
04/01/2020
Last updated
10/02/2025
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