Individual
GRANT I DISICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME101748
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1069247
CAREPLUS
FL
01
—
11999
DIMENSION
FL
01
—
319558
AVMED
FL
01
—
58335
BCBS
FL
01
—
7583920
AETNA
FL
01
—
9010497
CIGNA
FL
01
—
973866
WELLCARE
FL
01
—
P939616
OPTIMUM
FL
01
—
P998495
FREEDOM
FL
Enumeration date
01/01/2007
Last updated
03/16/2017
Update your record
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