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Individual

DR. BRIAN JACOB GRONDAHL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101021290
MI
207RC0000X
Cardiovascular Disease Physician
Primary
17241
ND
207RC0000X
Cardiovascular Disease Physician
68988
MN

Other

Enumeration date
11/02/2013
Last updated
06/07/2021
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