Individual
LISA M PORTER-GRENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
27379 DEQUINDRE, MADISON HEIGHTS, MI 48071
(248) 398-4488
(248) 398-4995
Mailing address
735 FAIRFAX ST, BIRMINGHAM, MI 48009
(248) 647-5774
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301407005
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3349763
—
MI
Enumeration date
08/09/2006
Last updated
07/08/2007
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