Individual
NICKALAUS LANE GRAMZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
755 E MCDOWELL RD FL 4, PHOENIX, AZ 85006-2506
(602) 521-3144
(602) 521-3661
Mailing address
6565 FANNIN ST, SUITE 1003, HOUSTON, TX 77030-2703
(713) 441-1100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
N4437
TX
207RC0000X
Cardiovascular Disease Physician
Primary
N4437
AZ
207RC0000X
Cardiovascular Disease Physician
N4437
TX
208000000X
Pediatrics Physician
N4437
TX
208M00000X
Hospitalist Physician
N4437
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
358659601
—
TX
05
—
358659602
—
TX
01
—
8FW348
BCBS
TX
01
—
8FW349
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/10/2010
Last updated
03/22/2021
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