Provider Demographics
NPI:1962966739
Name:RUSH, GRANT
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14276 SERRA VISTA PT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46040-8123
Mailing Address - Country:US
Mailing Address - Phone:765-215-0033
Mailing Address - Fax:
Practice Address - Street 1:14276 SERRA VISTA PT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46040-8123
Practice Address - Country:US
Practice Address - Phone:765-215-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management