Provider Demographics
NPI:1003027582
Name:GRANT, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S BROADWAY
Mailing Address - Street 2:SUITE 181
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6508
Mailing Address - Country:US
Mailing Address - Phone:701-857-3535
Mailing Address - Fax:
Practice Address - Street 1:831 S BROADWAY
Practice Address - Street 2:SUITE 113
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4636
Practice Address - Country:US
Practice Address - Phone:701-857-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND107662085R0001X
SD75632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology