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1801888524

NPI Code Detail

MEDICARE: DR. KIMBERLY ANN GRANDINETTI MD

MEDICARE: DR. KIMBERLY ANN GRANDINETTI MD

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	208000000X	Pediatrics Physician	MD23090	OR
2	208000000X	Pediatrics Physician	MD00046330	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8862602	OTHER	WA	MEDICARE PTAN
3	P00419722	OTHER	WA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801888524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN GRANDINETTI MD

Provider Business Mailing Address
First Line	:	322 W NORTH RIVER DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-3208
Country	:	US
Telephone Number	:	509-324-6464
Fax Number	:	509-324-3726

Provider Business Practice Location Address
First Line	:	322 W NORTH RIVER DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-3208
Country	:	US
Telephone Number	:	509-324-6464
Fax Number	:	509-324-3726

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	02/09/2012

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Directions to “ DR. KIMBERLY ANN GRANDINETTI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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