Provider Demographics
NPI:1316990781
Name:GRANT, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:818 N EMPORIA ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-263-5891
Mailing Address - Fax:316-263-3083
Practice Address - Street 1:818 N EMPORIA ST
Practice Address - Street 2:SUITE 310
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3729
Practice Address - Country:US
Practice Address - Phone:316-263-5891
Practice Address - Fax:316-263-3083
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-21446207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100199420AMedicaid
KS100122690AMedicaid
619860OtherFIRST GUARD
KS020071OtherBLUE CROSS BLUE SHIELD
110096522OtherRAILROAD MEDICARE
OK100199420AMedicaid
KS020071OtherBLUE CROSS BLUE SHIELD