Individual
ANTHONY L GRASCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 334-5081
(812) 334-5091
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085000553
IL
363A00000X
Physician Assistant
Primary
10004482A
IN
363AS0400X
Surgical Physician Assistant
085000553
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103641079
ANTHEM PTAN
IN
05
—
300095061
—
IN
Enumeration date
11/10/2005
Last updated
10/17/2024
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