Provider Demographics
NPI:1861445033
Name:GRANOFF, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:GRANOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:4789 ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7415
Practice Address - Country:US
Practice Address - Phone:630-898-5969
Practice Address - Fax:630-898-5837
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-040569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360405691Medicaid