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General NPI Number Information
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NPI Number | 1356434922
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Entity Type | Individual
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Provider Name | GRANT F. HALISCHUK MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1300 UNIVERSITY DR SUITE 4
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City | MENLO PARK
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State | CA
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Zip | 94025-4203
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Country | US
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Telephone | 650-261-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 3216 WOODSIDE RD
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City | WOODSIDE
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State | CA
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Zip | 94062-2555
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Country | US
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Telephone | 650-261-6655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C50658
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License Number State | CA
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