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General NPI Number Information
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NPI Number | 1922554831
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Entity Type | Individual
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Provider Name | ALEXANDER GRANTSARIS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 600 GRANT ST
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City | GARY
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State | IN
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Zip | 46402-6001
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Country | US
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Telephone | 219-886-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 3662 KINGSWAY DR
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City | CROWN POINT
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State | IN
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Zip | 46307-8936
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Country | US
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Telephone | 219-308-8041
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 115857
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28197039A
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License Number State | IN
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