Martin Theodore Grune

Key facts

NPI

1760411565

Entity type

Individual (NPI type 1)

Primary specialty

Urology Physician 208800000X

License

39996 (MN)

Practice address

400 E 3Rd St
Duluth, MN 55805-1951

Phone

(218) 786-8364

NPI assigned

Jul 2, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Essentia Health Moose Lake Critical Access Hospital · Moose Lake, MN · NPI 1154959880
  Medicare reassignment NPD MN
• Essentia Health Moose Lake Critical Access Hospital Clinic/Center · Moose Lake, MN · NPI 1275102048
  NPD
• Moose Lake Community Hospital District Critical Access Hospital · Moose Lake, MN · NPI 1942398029
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 10, 2011.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1760411565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNE",
        "first_name": "MARTIN",
        "middle_name": "THEODORE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "39996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32329100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116723500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

• James F Gruba, LP
• Stephanie L Grube, PHARMD
• Robert Richard Gruhl, MD
• Rebecca L Grumdahl, APRN, CRNA
• Erin Heather Grund, M.D.
• Taylor Ann Grupa, PHARMD
• Kevin Phillip Guenard, APRN, CNP
• Teresa J. Guerrero, L.I.C.S.W.
• Kaitlyn Jade Guertin Wilson
• Guided Transitions LLC

All providers in Duluth, MN · Urology Physician in Minnesota