1992865307 NPI number — MICHAEL GRANOFF LSCSW

Table of content: MICHAEL GRANOFF LSCSW (NPI 1992865307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992865307 NPI number — MICHAEL GRANOFF LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANOFF
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
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:
1992865307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 SHAWNEE MISSION PKWY
Provider Second Line Business Mailing Address:
SUITE 252
Provider Business Mailing Address City Name:
FAIRWAY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-677-2277
Provider Business Mailing Address Fax Number:
913-677-2229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 SOMERSET DR
Provider Second Line Business Practice Location Address:
STE 254
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-5213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-677-2277
Provider Business Practice Location Address Fax Number:
913-491-8448
Provider Enumeration Date:
12/08/2006

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: 1041C0700X , with the licence number:  1241 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 006065 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200400620A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29164021 . This is a "BCBS OF KC" identifier . This identifiers is of the category "OTHER".




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