IndividualActive
Mark Grandon, PA-C
NPI 1386683852 · Surgical Physician Assistant · Louisville, KY
Provider details
- NPI number
- 1386683852
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- PA155 (KY)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
3 Audubon Plaza Dr
Suite 560
Louisville, KY 40217-1319
Phone: (502) 636-8004
Fax: (502) 636-8384
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 776351
Chicago, IL 60677-6351
Registry dates
- Enumerated
- 2006-06-06
- Last updated
- 2016-07-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.