Provider Demographics
NPI:1912624263
Name:GRANZOW MEDICAL LLP
Entity Type:Organization
Organization Name:GRANZOW MEDICAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-874-9709
Mailing Address - Street 1:10700 BEACH BLVD UNIT 16428
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-8018
Mailing Address - Country:US
Mailing Address - Phone:904-325-9386
Mailing Address - Fax:310-882-6260
Practice Address - Street 1:4268 OLDFIELD CROSSING DR STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7899
Practice Address - Country:US
Practice Address - Phone:904-325-9386
Practice Address - Fax:310-882-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty