Individual
SUZANNE M GRANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8150 OAKLANDON ROAD, SUITE 130, INDIANAPOLIS, IN 46236-9543
(317) 621-1111
(317) 621-1110
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01057464A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
01057464
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200453750
—
IN
01
—
P01179052
RR MEDICARE PTAN
IN
Enumeration date
09/13/2006
Last updated
11/27/2023
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