Individual
DR. KEVIN J GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25319 LITTLE MACK AVE, SAINT CLAIR SHORES, MI 48081-3370
(586) 772-5550
(586) 772-1706
Mailing address
50505 SCHOENHERR RD, SUITE 290, SHELBY TOWNSHIP, MI 48315-3140
(586) 314-0080
(586) 731-6253
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301049952
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E00425
BLUE CROSS
MI
05
—
1762697
—
MI
Enumeration date
07/12/2006
Last updated
03/27/2012
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