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1639236797
GRANT I DISICK
BOCA RATON, FL
NPI
1639236797
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208800000X Urology
(Licence: FL ME101748)
Enumeration Date
2007-01-01
Last Update Date
2017-03-16
Business Address
-- GRANT I DISICK MD
9970 CENTRAL PARK BLVD N SUITE 207
BOCA RATON, FL 33428-2231
Phone number: 561-487-5506
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Mailing Address
-- GRANT I DISICK MD
2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
FORT MYERS, FL 33907-1412
Phone number: 239-931-7342
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