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Mark E Grandon, PA-C
Surgical Physician Assistant in Louisville, Kentucky
NPI 1386683852

Mark E Grandon is a Surgical Physician Assistant based in Chicago, KY and is specialized in Surgical. Mark E Grandon practices in Louisville, KY and has the professional credentials of PA-C. The NPI Number for Mark E Grandon is 1386683852 and holds a License No. PA155 (Kentucky).

The current practice location address for Mark E Grandon is 3 Audubon Plaza Dr, Louisville, KY and can be reached out via phone at 502-636-8004 and via fax at 502-636-8384. You can also correspond with Mark E Grandon through the mailing address at PO BOX 776351, CHICAGO, IL - 60677-6351 (mailing address contact number: 502-588-9490).

Location: 3 Audubon Plaza Dr, Louisville, KY, 60677-6351
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Provider Profile Details
NPI Number
1386683852
Provider Name
Mark E Grandon
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
3 Audubon Plaza Dr, Louisville, KY, 60677-6351
Phone Number
502-636-8004
Fax Number
502-636-8384
Provider Enumeration Date
06/06/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
121030 01 KY SIHO - CTS
50032501 01 KY PASSPORT/PASSPORT ADVANTAGE - CTS
95001558 05 KY
000000689934 01 KY ANTHEM - CTS
1299470001 01 KY PTAN
institution
Provider Business Practice Location Address Details
Address
3 Audubon Plaza Dr
City
State
Zip
40217-1319
Phone Number
502-636-8004
Fax Number
502-636-8384
person
Provider Business Mailing Address Details
Address
3 Audubon Plaza Dr
City
State
Zip
40217-1319
Phone Number
502-636-8004
Fax Number
502-636-8384
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
PA155 (Kentucky)
Definition
Definition to come...
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