Provider Demographics
NPI:1649233743
Name:GRANAT, PEPI (MD)
Entity Type:Individual
Prefix:DR
First Name:PEPI
Middle Name:
Last Name:GRANAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 SW 80TH ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4661
Mailing Address - Country:US
Mailing Address - Phone:305-661-7609
Mailing Address - Fax:305-667-8266
Practice Address - Street 1:6601 SW 80TH ST
Practice Address - Street 2:SUITE 200A
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4661
Practice Address - Country:US
Practice Address - Phone:305-661-7609
Practice Address - Fax:305-667-8266
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10937207Q00000X
FLME10937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255166700Medicaid
FL1649233743OtherNPI
FLD86242Medicare UPIN