Provider Demographics
NPI:1730107368
Name:GRANT, KEVIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1004 RIVER ROCK #131
Mailing Address - Street 2:#131
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2095
Mailing Address - Country:US
Mailing Address - Phone:916-989-6400
Mailing Address - Fax:916-635-8047
Practice Address - Street 1:13164 N. TOWN RIDGE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:916-989-6400
Practice Address - Fax:916-635-8047
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-08-26
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Provider Licenses
StateLicense IDTaxonomies
IDMV-0025208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-50152Medicare UPIN