Provider Demographics
NPI:1952345423
Name:GRANA, ERICK ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:ANTONIO
Last Name:GRANA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2333 W HILLSBOROUGH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1052
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:813-870-1502
Practice Address - Street 1:2333 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1052
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:813-870-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME666702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004792300Medicaid
FL004792300Medicaid
FLF26527Medicare UPIN