Provider Demographics
NPI:1881673382
Name:GRANBERG, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:GRANBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13131 TESSON FERRY RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3887
Mailing Address - Country:US
Mailing Address - Phone:314-756-8035
Mailing Address - Fax:314-756-8050
Practice Address - Street 1:13131 TESSON FERRY RD
Practice Address - Street 2:SUITE #105
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3887
Practice Address - Country:US
Practice Address - Phone:314-756-8035
Practice Address - Fax:314-756-8050
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-02-15
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Provider Licenses
StateLicense IDTaxonomies
MO104051207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208256917Medicaid
MO021010681Medicare PIN
MOG37517Medicare UPIN