Individual
DR. MICHAEL GRAINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7192
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 549-0677
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
200500993
NC
2085B0100X
Body Imaging Physician
ME98264
FL
2085R0202X
Diagnostic Radiology Physician
200500993
NC
2085R0202X
Diagnostic Radiology Physician
Primary
ME98264
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04621
BCBS
—
05
—
104337300
—
FL
01
—
AD657X
MEDICARE PTAN
—
01
—
M9568
MEDICARE HF
FL
Enumeration date
03/20/2007
Last updated
11/20/2020
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