Provider Demographics
NPI:1821451238
Name:GRANT, MICHAEL JUDE II (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JUDE
Last Name:GRANT
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 CEDAR ST # 205
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-4095
Mailing Address - Fax:203-785-4116
Practice Address - Street 1:333 CEDAR ST # 205
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-688-4242
Practice Address - Fax:203-785-4116
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72107207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty