Healthcare Provider Details

I. General information

NPI: 1568683548
Provider Name (Legal Business Name): GRANT PAULSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 7017
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 7017
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4578
  • Fax: 513-636-7039
Mailing address:
  • Phone: 513-636-4578
  • Fax: 513-636-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2009-00311
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009-00311
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30187
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35.124275
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35.124275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: