Healthcare Provider Details

I. General information

NPI: 1801409198
Provider Name (Legal Business Name): VOYA HEALTH MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N 4TH ST
LEWISBURG PA
17837-1403
US

IV. Provider business mailing address

139 N 4TH ST
LEWISBURG PA
17837-1403
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-4683
  • Fax:
Mailing address:
  • Phone: 248-761-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN A GRANT
Title or Position: FOUNDER
Credential: MD
Phone: 248-761-4683