Grand River Physical Medicine PLC

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

5101008610 Issued in MI

Legal business name

GRAND RIVER PHYSICAL MEDICINE PLC

Practice address

39915 Grand River Ave
Suite # 750
Novi, MI 48375-2153

Phone

(248) 476-7775

Fax

(248) 987-4972

NPI assigned

Apr 24, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shane Stanley

Title

Owner

Phone

(248) 476-7775

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kermit E White, M.D.

  • Family Medicine Physician
  • Farmington Hills, MI
  • NPI 1528045903
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371427200000",
    "number": "1699119339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39915 GRAND RIVER AVE",
            "address_2": "SUITE # 750",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752153",
            "telephone_number": "248-476-7775",
            "fax_number": "248-987-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39915 GRAND RIVER AVE",
            "address_2": "SUITE # 750",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752153",
            "telephone_number": "248-476-7775",
            "fax_number": "248-987-4972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER PHYSICAL MEDICINE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-24",
        "last_updated": "2013-06-17",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-476-7775",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "SS008515",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MI",
            "license": "5101008610",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704268297",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skyler Graham
• Tracey Grahl
• Emily Grajek
• Jovan M Granberry
• Grand Oaks Spine Center LLC
• Ashley Lynn Granica
• Daisy Grant
• Destiny Denise Grant
• Genise Grant
• Dakota Grasso

• Occupational Medicine Physician in Novi, MI
• Providers in Novi, MI by specialty
• Occupational Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.