Provider Demographics
NPI:1346400298
Name:GRANDISON, MICHAEL HENRY (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:GRANDISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 STANTON L YOUNG BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5021
Mailing Address - Country:US
Mailing Address - Phone:405-271-4113
Mailing Address - Fax:
Practice Address - Street 1:711 STANTON L YOUNG BLVD STE 215
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5021
Practice Address - Country:US
Practice Address - Phone:405-271-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program