Individual
BENJAMIN JOSEPH GRANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 435-7001
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-3834
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02005096A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245549
—
OH
05
—
300004384
—
IN
Enumeration date
03/25/2013
Last updated
01/02/2026
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