Provider Demographics
NPI:1205095254
Name:ERICK A GRANA M.D. PA
Entity type:Organization
Organization Name:ERICK A GRANA M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-935-1284
Mailing Address - Street 1:8011 N HIMES AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2700
Mailing Address - Country:US
Mailing Address - Phone:813-935-1284
Mailing Address - Fax:813-935-3773
Practice Address - Street 1:8011 N HIMES AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2700
Practice Address - Country:US
Practice Address - Phone:813-935-1284
Practice Address - Fax:813-935-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME666702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379108400Medicaid
FLF26527Medicare UPIN
FL27605Medicare PIN