| Doctor Name: | GRANT I DISICK |
| NPI Number: | 1639236797 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME101748 |
| Business Practice Address: | 9970 Central Park Blvd N Suite 207 Boca Raton, FL - 334282231 |
| Business Phone Number: | 5614875506 |
| Business Fax Number: | 5614879261 |
| Mailing Address: | 2234 Colonial Blvd, Attn: Payer Contracting & Relations Dept. FORT MYERS |
| State: | FL |
| Postal Code: | 339071412 |
| Phone Number: | 2399317342 |
| Fax Number: | 2399317385 |
| NPI Enumeration Date: | 01/01/2007 |
| NPI Last Update Date: | 05/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208800000X |
| License Number: | ME101748 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Urology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |