Grant Michael Wallenfelsz, MD
Emergency Medicine in Agana Heights, GU. Individual provider (NPI-1).
NPI number1194353318
StatusActive
Last updated in NPPESOct 2, 2025
Details
- NPI
- 1194353318
- Entity type
- Individual (NPI-1)
- Name
- Grant Michael Wallenfelsz
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 1, 2020
- Certification date
- Oct 2, 2025
- Last updated
- Oct 2, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | T3715 | TX | Yes |
| 207P00000X | Emergency Medicine | A187218 | CA | |
| 207P00000X | Emergency Medicine | M-2480 | GU |
Practice location
Bldg #50 Farenholt AveAgana Heights, GU 96910
Phone 671-344-9340
Mailing address
Psc 455 Box 208Fpo, AP 96540-0003
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