Provider Demographics
NPI:1316054208
Name:GRANDFIELD, CHRISTOPHER S (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:GRANDFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E 650 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8976
Mailing Address - Country:US
Mailing Address - Phone:219-741-8181
Mailing Address - Fax:219-778-3265
Practice Address - Street 1:502 LEGACY PLZ W
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5254
Practice Address - Country:US
Practice Address - Phone:219-741-8181
Practice Address - Fax:219-778-3265
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000922A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1089370002OtherDMERC
INP00248619OtherRAILROAD MEDICARE
IN4800032400OtherRAILROAD MEDICARE
IN200326020Medicaid
IN1089370001OtherDMERC
IN1316054208OtherRAILROAD MEDICARE
IN213580AMedicare ID - Type Unspecified
IN1089370002OtherDMERC
INP00248619OtherRAILROAD MEDICARE
IN200326020Medicaid