MEDICARE: MEKAIL GRANT

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
1	246QM0706X	Medical Technologist	46682	FL

General Provider Information

NPI Number	:	1720486350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEKAIL GRANT

Provider Business Mailing Address
First Line	:	805 52ND ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5512
Country	:	US
Telephone Number	:	562-508-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 52ND ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5512
Country	:	US
Telephone Number	:	562-508-9068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2014
Last Update Date	:	12/14/2014

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Directions to “ MEKAIL GRANT ” Practice Location

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