Individual
KENNETH M GRUNDFAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 HARRISON AVE, SUITE 4005, BOSTON, MA 02118-2905
(617) 638-7934
Mailing address
820 HARRISON AVE, SUITE 4005, BOSTON, MA 02118-2905
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
160725
MA
207Y00000X
Otolaryngology Physician
MD6119
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110061841A
—
MA
Enumeration date
04/06/2006
Last updated
11/03/2023
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