Grant, Clive S

Grant, Clive S is an individual health care provider with primary practice located at 200 1St St Sw , Rochester MN 55905-0001. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Grant, Clive S can be contacted via phone (507) 284-2511.

Contact Information

Primary practice address
200 1St St Sw Rochester MN 55905-0001
Phone: (507) 284-2511
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 22859 Minnesota

Profile Details

NPI number 1700864600
LBN Legal business name Grant, Clive S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2006
Last updated Sep 25th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700864600 NPPES
Wisconsin MEDICAID 35139900
Wisconsin MEDICAID 331725100
Wisconsin Other 020008415
Wisconsin MEDICAID ENROLLED

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