Provider Demographics
NPI:1255388906
Name:BOCHICCHIO, GRANT VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:VINCENT
Last Name:BOCHICCHIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-1010
Mailing Address - Country:US
Mailing Address - Phone:314-273-0500
Mailing Address - Fax:314-273-0455
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-5298
Practice Address - Fax:888-824-2176
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20110209102086S0102X, 2086S0102X
IL036.1504722086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205667504Medicaid
ILENROLLEDMedicaid
MO101740089Medicaid
MOP00993150Medicare PIN