Provider Demographics
NPI:1265439566
Name:GRANNIS, SHAUN J (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:J
Last Name:GRANNIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 W 10TH ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3002
Mailing Address - Country:US
Mailing Address - Phone:317-423-5523
Mailing Address - Fax:317-423-5695
Practice Address - Street 1:1520 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2213
Practice Address - Country:US
Practice Address - Phone:317-962-8188
Practice Address - Fax:317-423-5695
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN01055270A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine