Healthcare Provider Details

I. General information

NPI: 1306307343
Provider Name (Legal Business Name): JONATHAN GRABAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONN TER
LEXINGTON KY
40508-3206
US

IV. Provider business mailing address

740 S LIMESTONE ROOM K403
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-2101
  • Fax:
Mailing address:
  • Phone: 859-218-3044
  • Fax: 859-257-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberTP762
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: