Provider Demographics
NPI:1932280492
Name:GRNJA, VLADIMIR (MD)
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:GRNJA
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 1:210 S FEDERAL HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-927-1776
Mailing Address - Fax:954-927-0069
Practice Address - Street 1:210 S FEDERAL HWY STE 403
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:954-929-3449
Practice Address - Fax:954-929-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20137261QR0206X, 2085R0202X, 261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272884202Medicaid
FL272884202Medicaid
FLE2348Medicare ID - Type Unspecified