MEDICARE: MICHAEL HENRY GRANDISON DO

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	208D00000X	General Practice Physician	P7770	TX

General Provider Information

NPI Number	:	1346400298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HENRY GRANDISON DO

Provider Business Mailing Address
First Line	:	711 STANTON L YOUNG BLVD STE 215
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5021
Country	:	US
Telephone Number	:	405-271-4113
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 STANTON L YOUNG BLVD STE 215
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5021
Country	:	US
Telephone Number	:	405-271-4113
Fax Number	:

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	07/23/2025

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