Provider Demographics
NPI:1467780106
Name:VICTOR K GRANDT DPM INC
Entity Type:Organization
Organization Name:VICTOR K GRANDT DPM INC
Other - Org Name:IN STRIDE FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-624-1405
Mailing Address - Street 1:4946 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5243
Mailing Address - Country:US
Mailing Address - Phone:559-624-1405
Mailing Address - Fax:559-624-1746
Practice Address - Street 1:4946 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5243
Practice Address - Country:US
Practice Address - Phone:559-624-1405
Practice Address - Fax:559-624-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4724213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BG8445593OtherDEA
BG8445593OtherDEA
6319900001Medicare NSC