Healthcare Provider Details

I. General information

NPI: 1164486692
Provider Name (Legal Business Name): TIMOTHY L GRANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 SW 67TH AVE
MIAMI FL
33155-3710
US

IV. Provider business mailing address

PO BOX 160010
HIALEAH FL
33016-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-5552
  • Fax: 305-203-0617
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME30640
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberME30640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: