Basic Information
| Provider Information | |||||||||
| NPI: | 1003027582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 S BROADWAY | ||||||||
| Address2: | SUITE 181 | ||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587016508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018573535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 831 S BROADWAY | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018573535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 7563 | SD | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 10766 | ND | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.