MEDICARE: GRANT PRICE PA-C

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	363A00000X	Physician Assistant	5601009872	MI

General Provider Information

NPI Number	:	1386272938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT PRICE PA-C

Provider Business Mailing Address
First Line	:	621 COURT ST STE 104
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-8768
Country	:	US
Telephone Number	:	989-701-2293
Fax Number	:	989-701-2297

Provider Business Practice Location Address
First Line	:	621 COURT ST STE 104
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-8768
Country	:	US
Telephone Number	:	989-701-2293
Fax Number	:	989-701-2297

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	01/10/2023

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Directions to “ GRANT PRICE PA-C” Practice Location

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