Provider Demographics
NPI:1194773267
Name:GRANNIS, SHARRON PROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:SHARRON
Middle Name:PROBERT
Last Name:GRANNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7151 MARSH RD STE 150
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1631
Mailing Address - Country:US
Mailing Address - Phone:317-293-4113
Mailing Address - Fax:317-290-2542
Practice Address - Street 1:7151 MARSH RD STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1631
Practice Address - Country:US
Practice Address - Phone:317-293-4113
Practice Address - Fax:317-290-2542
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054775A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN203352230Medicaid
IN203352230Medicaid