Provider Demographics
NPI:1679785653
Name:GRANDE, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:GRANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO497062085R0202X, 2085R0204X
NE261212085R0202X
MO20050191042085R0202X
KS04-362832085R0202X
HI175272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1679785653Medicaid
AZ767467Medicaid
NE10026133600Medicaid
KS200870160AMedicaid
CO47525070Medicaid
AZ767467Medicaid
COP01394130Medicare PIN
COCOAAA1630Medicare PIN
COCOAAA3809Medicare PIN
OH$$$$$$$$$-00Medicaid
NE10026133600Medicaid
COCOAAA1631Medicare PIN
CO391966ZLJ3Medicare PIN
KSKA3249025Medicare PIN
CO47525070Medicaid
WY1679785653Medicaid
KS200870160AMedicaid
NECOAAA3806Medicare PIN
NENA1214069Medicare PIN
COP01001201Medicare PIN