Individual
JUSTIN GRANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
306 E VISTULA, BRISTOL, IN 46507-9489
(574) 848-4427
(574) 848-4592
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003881A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201023380
—
IN
Enumeration date
06/16/2010
Last updated
03/06/2025
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