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General NPI Number Information
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NPI Number | 1982809422
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Entity Type | Individual
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Provider Name | MICHAEL A GRANDNER PHD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 2800 E AJO WAY
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City | TUCSON
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State | AZ
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Zip | 85713-6204
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Country | US
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Telephone | 215-776-4391
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 MARKET STREET 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3309
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Country | US
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Telephone | 215-746-6701
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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 | PS016956
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License Number State | PA
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