Provider Demographics
NPI:1972659597
Name:GRANADILLO, ANN J (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:J
Last Name:GRANADILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 E HAMPDEN AVE
Mailing Address - Street 2:ENGLEWOOD
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-788-7888
Mailing Address - Fax:303-788-7592
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:ENGLEWOOD
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-7888
Practice Address - Fax:303-788-7592
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53678346Medicaid
CO53678346Medicaid