Provider Demographics
NPI:1699821892
Name:GRANQUIST, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GRANQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:305 WESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4380
Mailing Address - Country:US
Mailing Address - Phone:860-522-0604
Mailing Address - Fax:860-659-8077
Practice Address - Street 1:CONSULTING CARDIOLOGISTS, P.C.
Practice Address - Street 2:85 SEYMOUR STREET SUITE 719
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-522-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045097207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001810Medicare PIN