Provider Demographics
NPI:1285816637
Name:GRANDHIGE, GOPAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:S
Last Name:GRANDHIGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 S HOWARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3193
Mailing Address - Country:US
Mailing Address - Phone:813-922-2920
Mailing Address - Fax:813-742-0711
Practice Address - Street 1:1315 S HOWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3193
Practice Address - Country:US
Practice Address - Phone:813-922-2920
Practice Address - Fax:813-742-0711
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046718208600000X
FLME105346208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery