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General NPI Number Information
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NPI Number | 1902804198
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Entity Type | Individual
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Provider Name | KENNETH A GRINSPUN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 105 S WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-4667
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Country | US
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Telephone | 931-526-9518
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Fax | 931-372-0087
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Provider Business Mailing Address
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Address Line | 105 S WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-4667
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Country | US
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Telephone | 931-526-9518
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Fax | 931-372-0087
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 16020
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 55872
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD42863
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License Number State | TN
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