Individual
VICTOR JOSE ANCIANO GRANADILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4402 CHURCHMAN AVE STE 300, LOUISVILLE, KY 40215-3101
(502) 363-0588
(502) 363-0972
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
55434
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0397730024
NSC#
NC
05
—
300053739
—
IN
05
—
7100757450
—
KY
Enumeration date
04/15/2015
Last updated
08/24/2021
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