MEDICARE: DR. BRADLEY P GRANT 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	207N00000X	Dermatology Physician	ME80040	FL
2	207ND0101X	MOHS-Micrographic Surgery Physician	ME80040	FL
3	207NS0135X	Procedural Dermatology Physician	ME80040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51915	OTHER	FL	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2120225050101	OTHER	FL	BEECH STREET
4	CIGNA	OTHER	FL	0560163

General Provider Information

NPI Number	:	1528066073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY P GRANT M.D.

Provider Business Mailing Address
First Line	:	1480 S WICKHAM RD
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-2447
Country	:	US
Telephone Number	:	321-724-2188
Fax Number	:	321-724-2833

Provider Business Practice Location Address
First Line	:	1480 S WICKHAM RD
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-2447
Country	:	US
Telephone Number	:	321-724-2188
Fax Number	:	321-724-2833

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	06/06/2008

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1083894125 — BRADLEY P GRANT MD PA
Practice Location Address:

1480 S WICKHAM RD
W MELBOURNE, FL
32904-2447

Practice Phone: 321-724-2188
Practice Fax: 321-724-2833

1891733044 — ALBERTSONS LLC
Practice Location Address:

2447 100 WICKHAM RD
MELBOURNE, FL
32935

Practice Phone: 321-242-1955
Practice Fax: 321-757-6306

1407951403 — DR. MUHAMMAD R ALI BDS
Practice Location Address:

2447 N WICKHAM RD STE 116
MELBOURNE, FL
32935-8127

Practice Phone: 321-956-0999
Practice Fax: 321-752-4274

1104077841 — MISS DENISE ELLIOTT RN CRNI
Practice Location Address:

2447 N WICKHAM RD STE 138 , PMB 147
MELBOURNE, FL
32935-8127

Practice Phone: 186-654-5742
Practice Fax:

1114973997 — MONICA RUTH CASEY D.C.
Practice Location Address:

7639 W BELOIT RD
WEST ALLIS, WI
53219-2447

Practice Phone: 414-543-1951
Practice Fax: 414-543-1595

Directions to “ DR. BRADLEY P GRANT M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.