Individual
RICHARD KELLY GRENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10628 PARK RD, CHARLOTTE, NC 28210-8407
(555) 555-5555
Mailing address
10628 PARK RD, CHARLOTTE, NC 28210-8407
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1689201071
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2020
Last updated
06/30/2023
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