Provider Demographics
NPI:1891840344
Name:CAICEDO-GRANADOS, EMIRO (MD)
Entity Type:Individual
Prefix:
First Name:EMIRO
Middle Name:
Last Name:CAICEDO-GRANADOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 396
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-3200
Mailing Address - Fax:612-625-2101
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 396
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-3200
Practice Address - Fax:612-625-2101
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16749207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology