Provider Demographics
NPI:1679551014
Name:GRANT, CALVIN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:ALEXANDER
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 W COLLEGE DR
Mailing Address - Street 2:SUITE 1-NW
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1027
Mailing Address - Country:US
Mailing Address - Phone:708-499-0123
Mailing Address - Fax:708-499-0611
Practice Address - Street 1:7808 W COLLEGE DR
Practice Address - Street 2:SUITE 1-NW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-499-0123
Practice Address - Fax:708-499-0611
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205786OtherPTAN IL MEDICARE DUPAGE COUNTY
IL036111343Medicaid
IL205785OtherPTAN IL MEDICARE COOK COUNTY
IL036051267Medicaid
ILP00638025OtherMEDICARE RAILROAD IL
IL1679551014OtherNPI
ILK47805OtherPTAN
IL205785OtherPTAN IL MEDICARE COOK COUNTY
ILH18689Medicare UPIN