Provider Demographics
NPI:1811008204
Name:GRANDFIELD, STEPHEN KEITH (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:GRANDFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6294
Mailing Address - Country:US
Mailing Address - Phone:219-736-8915
Mailing Address - Fax:219-736-8928
Practice Address - Street 1:303 W 89TH AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6294
Practice Address - Country:US
Practice Address - Phone:219-736-8915
Practice Address - Fax:219-736-8928
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000353A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100166360AMedicaid
IN100166360BMedicaid
IN1089370001OtherMEDICARE DMERC
IN480016271OtherRR MEDICARE
IN100207960AMedicaid
IN653120AMedicare PIN
IN100207960AMedicaid
IN492470AMedicare PIN