Grandon, Mark E

Grandon, Mark E is an individual health care provider with primary practice located at 3 Audubon Plaza Dr Suite 560, Louisville KY 40217-1319. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Grandon, Mark E can be contacted via phone (502) 636-8004.

Contact Information

Primary practice address
3 Audubon Plaza Dr Suite 560 Louisville KY 40217-1319
Phone: (502) 636-8004
Fax: (502) 636-8384
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA155 Kentucky

Profile Details

NPI number 1386683852
LBN Legal business name Grandon, Mark E
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Jul 9th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386683852 NPPES
Kentucky Other 121030 SIHO - CTS
Kentucky Other 50032501 SIHO - CTS
Kentucky MEDICAID 95001558 SIHO - CTS
Kentucky Other 000000689934 SIHO - CTS
Kentucky Other 1299470001 SIHO - CTS

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