| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MICHAEL STEFAN GRAVENSTEIN | 1093395303 | 2021-04-11 |
Michael Stefan Gravenstein is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1093395303. Registration indicates Michael Stefan Gravenstein is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Michael Stefan Gravenstein MD |
| Practice Office Address | 4101 NW 89TH BLVD RM 1788 GAINESVILLE, FL US |
| Practice Office Telephone | 3522652862 |
| Mailing Address | 4101 NW 89TH BLVD RM 1788 GAINESVILLE, FL 326063813 US |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |