MEDICARE: DR. MICHAEL SCOTT GRAD M.D.

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	207RI0011X	Interventional Cardiology Physician	L4956	TX
2	207RC0000X	Cardiovascular Disease Physician	L4956	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00246014	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1386629012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT GRAD M.D.

Provider Business Mailing Address
First Line	:	2200 PARK BEND DR
Second Line	:	BLDG 1 SUITE 401
City	:	AUSTIN
State	:	TX
Zip	:	78758-5387
Country	:	US
Telephone Number	:	512-901-4001
Fax Number	:	512-339-7743

Provider Business Practice Location Address
First Line	:	2200 PARK BEND DR
Second Line	:	BLDG 1 SUITE 401
City	:	AUSTIN
State	:	TX
Zip	:	78758-5387
Country	:	US
Telephone Number	:	512-615-9901
Fax Number	:	512-807-3335

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	05/16/2023

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Directions to “ DR. MICHAEL SCOTT GRAD M.D.” Practice Location

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