Provider Demographics
NPI:1073876520
Name:GHAHRAMANI, GRANT (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:GHAHRAMANI
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 1:6650 SW MISSION VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5654
Mailing Address - Country:US
Mailing Address - Phone:785-272-1250
Mailing Address - Fax:785-272-1845
Practice Address - Street 1:6650 SW MISSION VALLEY DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5654
Practice Address - Country:US
Practice Address - Phone:785-272-1250
Practice Address - Fax:785-272-1845
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201136600AMedicaid
KS1073876520Medicare PIN