| Dr Dietmar J Grentz, MD | |
|
2725 Airview Blvd, Ste 105, Portage, MI 49002-1803 | |
| (269) 349-8386 | |
| (269) 349-8397 |
| Full Name | Dr Dietmar J Grentz |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 2725 Airview Blvd, Portage, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346269586 | NPI | - | NPPES |
| M97310016 | Other | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 39564 (Minnesota) | Secondary |
| 207Q00000X | Family Medicine | 4301069296 (Michigan) | Primary |
| 207Q00000X | Family Medicine | 036069689 (Illinois) | Secondary |
| Entity Name | Vpa Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336153295 PECOS PAC ID: 9234041948 Enrollment ID: O20031103000102 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Dietmar J Grentz, MD 7088 Green Timber Ct, Greenville, MI 48838-8193 Ph: (616) 712-6436 | Dr Dietmar J Grentz, MD 2725 Airview Blvd, Ste 105, Portage, MI 49002-1803 Ph: (269) 349-8386 |
Brandon J Manderle, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 2700 E Centre Ave, Portage, MI 49002 Phone: 269-286-7050 | |
Carolyn Von Maur, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7901 Angling Road, Suite B-201, Portage, MI 49024 Phone: 269-324-8600 | |
Dr. Xue Wang, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7901 Angling Rd, Portage, MI 49024 Phone: 269-324-8600 | |
Remnant Mwanahiba, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2700 E Centre Ave, Portage, MI 49002 Phone: 269-286-7050 | |
Dr. Ann M. Busha, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 3300 W Centre Ave, Portage, MI 49024 Phone: 269-324-8950 Fax: 269-324-2134 | |
Amber Darey, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3300 W Centre Ave, Portage, MI 49024 Phone: 269-324-8950 Fax: 269-324-2134 | |
Lawrence Ulmer, Family Medicine Medicare: Medicare Enrolled Practice Location: 7901 Angling Rd, Suite B-201, Portage, MI 49024 Phone: 269-324-8600 Fax: 269-324-8617 |