Provider Demographics
NPI:1780664573
Name:GRAIN, PETER G (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:GRAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2603 ELECTRIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6588
Mailing Address - Country:US
Mailing Address - Phone:810-987-1056
Mailing Address - Fax:810-987-1060
Practice Address - Street 1:2603 ELECTRIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:810-987-1056
Practice Address - Fax:810-987-1060
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-01-05
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Provider Licenses
StateLicense IDTaxonomies
MI4301069603207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103409558Medicaid
MI0580808OtherAETNA HEALTH PLANS
MI15231OtherM-CARE
MID16645OtherHEALTH ALLIANCE PLAN
MI1406326922OtherBLUE CROSS BLUE SHIELD
MIP00171032OtherRAILROAD MEDICARE
MI104604735Medicaid
MI0999859OtherHEALTH PLUS OF MICHIGAN
MI0999859OtherHEALTH PLUS OF MICHIGAN
MI1406326922OtherBLUE CROSS BLUE SHIELD
MID16645OtherHEALTH ALLIANCE PLAN