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NPI Code Detail

MEDICARE: LINETTE I GRANGE D.O

MEDICARE: LINETTE I GRANGE D.O
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
1207Q00000XFamily Medicine Physician02003654IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01123184OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982646485
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINETTE I GRANGE D.O
Provider Business Mailing Address
First Line : 3702 NEW VISION DR BLDG B
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1703
Country : US
Telephone Number : 260-266-6013
Fax Number :
Provider Business Practice Location Address
First Line : 1025 MANCHESTER AVE
Second Line :
City : WABASH
State : IN
Zip : 46992-1425
Country : US
Telephone Number : 260-563-7421
Fax Number : 260-569-2284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 11/10/2017

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