Active NPI
Irene Grudsky
- Contractor
- Minnetonka, MN
National Provider Identifier
1548658982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 1075653
- Practice address
- 10550 Wayzata Blvd
Minnetonka, MN 55305 - Phone
- (763) 694-0222
- NPI assigned
- Jan 8, 2015
- Last updated
- Jan 8, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 1075653 | MN | Primary |
Addresses
Primary practice location
10550 Wayzata Blvd
Minnetonka, MN 55305
Mailing address
6384 Shadyview Lane North
Maple Grove, MN 55311
Phone (763) 222-8051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1075653 | MN | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420675200000",
"number": "1548658982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6384 SHADYVIEW LANE NORTH",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "55311",
"telephone_number": "763-222-8051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10550 WAYZATA BLVD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "55305",
"telephone_number": "763-694-0222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUDSKY",
"first_name": "IRENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-08",
"last_updated": "2015-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MN",
"license": "1075653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.