Provider Demographics
NPI:1528057270
Name:GRANOWICZ, VINCENT J (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:GRANOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30701 WOODWARD AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0987
Mailing Address - Country:US
Mailing Address - Phone:248-288-6500
Mailing Address - Fax:248-288-2272
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-288-6500
Practice Address - Fax:248-288-2272
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI004688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4379767 11Medicaid
MION39540Medicare ID - Type Unspecified
MI4379767 11Medicaid