Organization
TOTAL PEDIATRIC HEALTHCAREII
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEWART A GRANT M.D. (PRESIDENT)
(863) 815-3775
Entity
Organization
Contact information
Practice address
930 MARCUM RD, LAKELAND, FL 33809-4308
(863) 815-3775
(863) 815-3765
Mailing address
5337 N SOCRUM LOOP RD, 320, LAKELAND, FL 33809-4256
(863) 815-3775
(863) 815-3765
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME72163
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01106700
AMERIGROUP
FL
01
—
10880601
CITRUSCAID
FL
01
—
132800
AETNA
FL
01
—
225385
WELLCARE
—
01
—
2321757001
CIGNA
—
05
—
268531100
—
FL
01
—
41515
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/10/2009
Last updated
06/10/2009
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