Individual
DR. DANIEL LEE GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-6416
(208) 367-2742
Mailing address
PO BOX 7411114, CHICAGO, IL 60674-1114
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
O-0492
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005794100
—
MN
01
—
P00448262
MEDICARE RAILROAD
MN
Enumeration date
10/24/2005
Last updated
10/02/2023
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