MEDICARE: SUZANNE M GRANNAN 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	2080N0001X	Neonatal-Perinatal Medicine Physician	01057464	IN
2	208000000X	Pediatrics Physician	01057464A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01179052	OTHER	IN	RR MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275638777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE M GRANNAN MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8150 OAKLANDON ROAD
Second Line	:	SUITE 130
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9543
Country	:	US
Telephone Number	:	317-621-1111
Fax Number	:	317-621-1110

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	11/27/2023

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Directions to “ SUZANNE M GRANNAN MD” Practice Location

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