Provider Demographics
NPI:1538398706
Name:GRAU, KIRSTEN (DPM)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:GRAU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-7958
Mailing Address - Country:US
Mailing Address - Phone:815-382-5940
Mailing Address - Fax:
Practice Address - Street 1:27 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-7958
Practice Address - Country:US
Practice Address - Phone:518-283-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NYN006714213ES0103X
WAPO60300312213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program