Individual
DR. DIETMAR J GRENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2725 AIRVIEW BLVD, STE 105, PORTAGE, MI 49002-1803
(269) 349-8386
(269) 349-8397
Mailing address
7088 GREEN TIMBER CT, GREENVILLE, MI 48838-8193
(616) 712-6436
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036069689
IL
207Q00000X
Family Medicine Physician
39564
MN
207Q00000X
Family Medicine Physician
Primary
4301069296
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M97310016
MEDICARE
—
Enumeration date
07/19/2006
Last updated
07/22/2016
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