Individual
DR. GRANT NISKANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2865 DAGGETT AVE., KLAMATH FALLS, OR 97601
(541) 882-6311
(541) 882-6311
Mailing address
2865 DAGGETT AVE., KLAMATH FALLS, OR 97601
(541) 882-6311
(541) 882-6311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9782
NH
207Q00000X
Family Medicine Physician
Primary
MD18831
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006600
—
OR
01
—
0108854YPNH02
ANTHEM BC/BS
NH
05
—
30009720
—
NH
01
—
3059734PNH02
CIGNA
NH
01
—
5830418
AETNA
—
01
—
8782
STATE LICENSE #
NH
01
—
POO100692
RAILROAD MEDICARE
—
Enumeration date
08/15/2005
Last updated
03/07/2023
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