Provider Demographics
NPI:1053458117
Name:AGRANOFF, ADAM BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:BENJAMIN
Last Name:AGRANOFF
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 1:14650 E OLD US HIGHWAY 12
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1801
Mailing Address - Country:US
Mailing Address - Phone:734-475-3923
Mailing Address - Fax:734-475-4071
Practice Address - Street 1:14650 E OLD US HIGHWAY 12
Practice Address - Street 2:SUITE 203
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1801
Practice Address - Country:US
Practice Address - Phone:734-475-3923
Practice Address - Fax:734-475-4071
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069964208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
131672OtherCARE CHOICES
C7692OtherMCARE
AA069964OtherBCBS
131672OtherCARE CHOICES