Healthcare Provider Details

I. General information

NPI: 1982809422
Provider Name (Legal Business Name): MICHAEL A GRANDNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

3535 MARKET STREET 2ND FLOOR
PHILADELPHIA PA
19104-3309
US

V. Phone/Fax

Practice location:
  • Phone: 215-776-4391
  • Fax:
Mailing address:
  • Phone: 215-746-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPS016956
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: