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NPI Code Detail

MEDICARE: MR. KEVIN PAUL GRINNELL

MEDICARE: MR. KEVIN PAUL GRINNELL
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1114446812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN PAUL GRINNELL
Provider Business Mailing Address
First Line : 4039 NW BLITCHTON RD
Second Line :
City : OCALA
State : FL
Zip : 34475-6763
Country : US
Telephone Number : 352-804-3624
Fax Number :
Provider Business Practice Location Address
First Line : 1010 E ROSE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-2016
Country : US
Telephone Number : 863-519-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 06/27/2025

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Directions to “ MR. KEVIN PAUL GRINNELL ” Practice Location

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