Individual
DR. MICHAEL STEWART GRANDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.A.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
L.P.A. 2157
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046G3
BLUE CROSS BLUE SHIELD
NC
05
—
6107122
—
NC
Enumeration date
01/30/2007
Last updated
07/08/2007
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