MEDICARE: DR. KIRK FREDRICK GRANLUND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	A65440	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ528462	OTHER		BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063481893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK FREDRICK GRANLUND MD

Provider Business Mailing Address
First Line	:	131 RALEY BLVD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-8347
Country	:	US
Telephone Number	:	530-897-4500
Fax Number	:	530-897-4544

Provider Business Practice Location Address
First Line	:	131 RALEY BLVD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-8347
Country	:	US
Telephone Number	:	530-897-4500
Fax Number	:	530-897-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	10/26/2020

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