MEDICARE: MR. ROBERT DENNIS GRANT JR.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659134641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DENNIS GRANT JR.

Provider Business Mailing Address
First Line	:	10811 MASSIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3653
Country	:	US
Telephone Number	:	216-337-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	14405 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3433
Country	:	US
Telephone Number	:	216-337-6311
Fax Number	:

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

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “ MR. ROBERT DENNIS GRANT JR. ” Practice Location

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