Healthcare Provider Details

I. General information

NPI: 1568385888
Provider Name (Legal Business Name): MASON MICHAEL GRANGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N NEVADA AVE STE 1000
COLORADO SPRINGS CO
80903-1719
US

IV. Provider business mailing address

2 N. NEVADA AVE, SUITE 1000
COLORADO SPRINGS CO
80903
US

V. Phone/Fax

Practice location:
  • Phone: 866-226-8576
  • Fax: 719-387-8928
Mailing address:
  • Phone: 866-226-8576
  • Fax: 719-387-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: