Provider Demographics
NPI:1629166004
Name:GRANT, GREGORY STUART (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STUART
Last Name:GRANT
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 1:5940 OAK POINT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4100
Mailing Address - Country:US
Mailing Address - Phone:440-988-3705
Mailing Address - Fax:440-988-7433
Practice Address - Street 1:5940 OAK POINT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4100
Practice Address - Country:US
Practice Address - Phone:440-988-3705
Practice Address - Fax:440-988-7433
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2594643Medicaid
OH2594643Medicaid
OHI34999Medicare UPIN
OHGR4163682Medicare ID - Type UnspecifiedMILAN OFFICE