Provider Demographics
NPI:1447124169
Name:SMURAWA, GRANT MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:MICHAEL
Last Name:SMURAWA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 S 116TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2170
Mailing Address - Country:US
Mailing Address - Phone:352-697-1889
Mailing Address - Fax:
Practice Address - Street 1:8810 WILLIAM COFFEY DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1264
Practice Address - Country:US
Practice Address - Phone:414-805-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1108725-30207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty