Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4842 | AZ |
NPI | 1033304530 |
---|---|
Provider Name | Dr. Michael Grabow |
First Address | Chandler, AZ 85226-5940 |
Second Address | Chandler, AZ 85226-5940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2007 |
Last Update Date | 09/09/2007 |