Provider Demographics
NPI:1699760983
Name:MCDOUGAL, GRANT E (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:E
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9011 N MERIDIAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5365
Mailing Address - Country:US
Mailing Address - Phone:317-574-4747
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:8205 E 56TH ST STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1097
Practice Address - Country:US
Practice Address - Phone:317-353-8985
Practice Address - Fax:317-353-2389
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-05-14
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Provider Licenses
StateLicense IDTaxonomies
IN01051076A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200444340Medicaid
H90578Medicare UPIN
IN200444340Medicaid
IN796270IIMedicare PIN