Provider Demographics
NPI:1336571900
Name:GRANT, KARL W (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:W
Last Name:GRANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803886
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3886
Mailing Address - Country:US
Mailing Address - Phone:816-271-8265
Mailing Address - Fax:168-232-2991
Practice Address - Street 1:5001 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64504-1170
Practice Address - Country:US
Practice Address - Phone:162-387-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25402207Q00000X
MO2016008771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1336571900Medicaid
MO1336571900Medicaid
MOMA4680023Medicare PIN