Provider Demographics
NPI:1588646814
Name:GRANT, MICHAEL P (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-586-2200
Mailing Address - Fax:970-577-4536
Practice Address - Street 1:555 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6312
Practice Address - Country:US
Practice Address - Phone:970-586-2200
Practice Address - Fax:970-577-4536
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30819207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40287254Medicaid
COC802320Medicare PIN
CO802320Medicare PIN
COCO304773Medicare PIN
CO40287254Medicaid
G77863Medicare UPIN