Healthcare Provider Details

I. General information

NPI: 1902903859
Provider Name (Legal Business Name): HELEN H. GRANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date: 07/18/2007
Reactivation Date: 07/31/2007

III. Provider practice location address

610 GALL ST
LOWER BRULE SD
57548
US

IV. Provider business mailing address

PO BOX 467
CHAMBERLAIN SD
57325-0467
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-8234
  • Fax:
Mailing address:
  • Phone: 605-473-8229
  • Fax: 605-473-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN19642
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: