Individual
BRADLEY L GRINCEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
31700 VAN DYKE AVE STE 100, WARREN, MI 48093-7951
(586) 693-0431
(586) 693-0432
Mailing address
31700 VAN DYKE AVE STE 100, WARREN, MI 48093-7951
(586) 693-0431
(586) 693-0432
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006430
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E04360
BLUE CROSS BLUE SHIELDS OF MICHIGAN
MI
Enumeration date
08/22/2012
Last updated
08/10/2020
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