Provider Demographics
NPI:1821280462
Name:LUIS E GRAU MD PA
Entity Type:Organization
Organization Name:LUIS E GRAU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:305-823-3131
Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:305-823-3131
Mailing Address - Fax:305-558-4267
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:305-823-3131
Practice Address - Fax:305-558-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90687208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47356OtherBCBS
FLK6286OtherMEDICARE GROUP NUMBER
FLK6286OtherMEDICARE GROUP NUMBER
FL47356OtherBCBS