1891812574 NPI number — DR. ROBERT D GRANDE

Table of content: DR. ROBERT D GRANDE (NPI 1891812574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891812574 NPI number — DR. ROBERT D GRANDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANDE
Provider First Name:
ROBERT
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891812574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2940 N MCCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43615-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-842-3000
Provider Business Mailing Address Fax Number:
419-842-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2940 N MCCORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43615-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-842-3000
Provider Business Practice Location Address Fax Number:
419-842-3042
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  4301084238 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 35095842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06927 . This is a "PARAMOUNT HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3076291 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000673192 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9032573 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00864034 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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