Organization
CENTRAL MICHIGAN UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY J GRONDA (CREDENTIALING OFFICER)
(989) 583-7415
Entity
Organization
Contact information
Practice address
1201 SOUTH DR, STE. 341, MT PLEASANT, MI 48858-3256
(989) 779-5270
(989) 779-5279
Mailing address
1201 SOUTH DR, STE. 341, MT PLEASANT, MI 48858-3256
(989) 779-5270
(989) 779-5279
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/03/2013
Last updated
07/03/2013
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