MEDICARE: PER GRANSTROM MD

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	2085R0202X	Diagnostic Radiology Physician	22167	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300088215	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1851365647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PER GRANSTROM MD

Provider Business Mailing Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-7124
Country	:	US
Telephone Number	:	520-874-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 E PRINCE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2005
Country	:	US
Telephone Number	:	520-874-3500
Fax Number	:

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	05/15/2008

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Directions to “ PER GRANSTROM MD” Practice Location

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