Individual
MR. MICHAEL J GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2865 CHANCELLOR DR STE 205, CRESTVIEW HILLS, KY 41017-3931
(859) 341-9900
(859) 341-1649
Mailing address
6 GREENBRIAR AVE, FT MITCHELL, KY 41017-2752
(859) 907-5517
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
244156
KY
213E00000X
Podiatrist
36003524
OH
213E00000X
Podiatrist
Primary
K237
KY
213ER0200X
Radiology Podiatrist
244156
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
244156
KY
213ES0131X
Foot Surgery Podiatrist
244156
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000304180
BLUES
KY
01
—
000000636981
ANTHEM BCBS
OH
01
—
4949440001
MDCR DMERC
KY
05
—
80002371
—
KY
Enumeration date
09/11/2006
Last updated
03/16/2022
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