Individual
KENNETH GRANKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2104 E 11 MILE RD, SUITE 600, WARREN, MI 48091-6122
(734) 464-0887
(734) 402-0254
Mailing address
4967 CROOKS RD, STE 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-1614
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301046290
MI
2086S0129X
Vascular Surgery Physician
4301046290
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851338347
—
MI
Enumeration date
06/01/2006
Last updated
07/24/2024
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