MEDICARE: DR. DAVID WILLIAM 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
1	208200000X	Plastic Surgery Physician	2014018072	MO
2	390200000X	Student in an Organized Health Care Education/Training Program	4351045888	MI

General Provider Information

NPI Number	:	1790191047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILLIAM GRANT M.D.

Provider Business Mailing Address
First Line	:	1500 EAST MEDICAL CENTER DRIVE
Second Line	:	2130 TAUBMAN CENTER, SPC 5340
City	:	ANN ARBOR
State	:	MI
Zip	:	48109
Country	:	US
Telephone Number	:	312-498-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 EAST MEDICAL CENTER DRIVE
Second Line	:	2130 TAUBMAN CENTER, SPC 5340
City	:	ANN ARBOR
State	:	MI
Zip	:	48109
Country	:	US
Telephone Number	:	312-498-1141
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/28/2020

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