Provider Demographics
NPI:1043492499
Name:MICHAEL T. GRANT, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL T. GRANT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-677-6404
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:BUILDING B, SUITE 105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-6404
Mailing Address - Fax:716-677-6407
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:BUILDING B, SUITE 105
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-6404
Practice Address - Fax:716-677-6407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL T. GRANT, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00886879Medicaid
NYD01446Medicare UPIN