Active NPI
Michael Edward Grant, MD,PHD
- Specialist
- Blaine, MN
National Provider Identifier
1902112253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 502209
- Practice address
- 3890 Pheasant Ridge Dr NE
Blaine, MN 55449-5854 - Phone
- (763) 792-9507
- Fax
- (763) 792-9514
- NPI assigned
- Aug 25, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 502209 | MN | Primary |
Addresses
Primary practice location
3890 Pheasant Ridge Dr NE
Blaine, MN 55449-5854
Mailing address
3890 Pheasant Ridge Dr NE
Blaine, MN 55449-5854
Phone (763) 792-9507
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 502209 | Other | MN | BOARD OF PHARMANCY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 502209 | MN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1902112253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3890 PHEASANT RIDGE DR NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554495854",
"telephone_number": "763-792-9507",
"fax_number": "763-792-9514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3890 PHEASANT RIDGE DR NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554495854",
"telephone_number": "763-792-9507",
"fax_number": "763-792-9514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "MICHAEL",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "MD,PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-25",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "502209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PHARMANCY LICENSE",
"identifier": "502209",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.