Provider Demographics
NPI:1043283286
Name:GRANADOS, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5958 N CANTON CENTER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2769
Mailing Address - Country:US
Mailing Address - Phone:734-667-1648
Mailing Address - Fax:734-667-1649
Practice Address - Street 1:5958 N CANTON CENTER RD
Practice Address - Street 2:STE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2769
Practice Address - Country:US
Practice Address - Phone:734-667-1648
Practice Address - Fax:734-667-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51798Medicare UPIN