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NPI Code Detail

MEDICARE: KENNETH DOUGLAS GRANT M.D.

MEDICARE: KENNETH DOUGLAS GRANT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RR0500XRheumatology Physician9894NV

General Provider Information

NPI Number : 1093793796
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH DOUGLAS GRANT M.D.
Provider Business Mailing Address
First Line : 1801 W OLYMPIC BLVD # 2265
Second Line :
City : PASADENA
State : CA
Zip : 91199-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 874 AMERICAN PACIFIC DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-8800
Country : US
Telephone Number : 702-777-4809
Fax Number : 702-777-4822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 10/27/2020

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