Provider Demographics
NPI:1619728615
Name:GRANADA PSYCHIATRY L L C
Entity Type:Organization
Organization Name:GRANADA PSYCHIATRY L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAQHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-673-2937
Mailing Address - Street 1:7422 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7714
Mailing Address - Country:US
Mailing Address - Phone:928-785-7382
Mailing Address - Fax:
Practice Address - Street 1:333 W BROWN DEER RD UNIT G-576
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-2372
Practice Address - Country:US
Practice Address - Phone:928-785-7382
Practice Address - Fax:734-402-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty