Provider Demographics
NPI:1750837068
Name:MICHELLE R. GRANA, DO; PC
Entity Type:Organization
Organization Name:MICHELLE R. GRANA, DO; PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRANA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-429-2212
Mailing Address - Street 1:470 PROVIDENCE MAIN ST NW STE 302A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4843
Mailing Address - Country:US
Mailing Address - Phone:256-429-2212
Mailing Address - Fax:256-867-0995
Practice Address - Street 1:470 PROVIDENCE MAIN ST NW STE 302A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4843
Practice Address - Country:US
Practice Address - Phone:256-429-2212
Practice Address - Fax:256-867-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty