Provider Demographics
NPI:1013026798
Name:GRANT, STEPHEN BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BERNARD
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-9600
Mailing Address - Fax:515-358-9650
Practice Address - Street 1:1449 NW 128TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7400
Practice Address - Country:US
Practice Address - Phone:515-358-9600
Practice Address - Fax:515-358-9650
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38506173F00000X
IAMD-38506207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0167122Medicaid
I1176002Medicare PIN