Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD450700 | PA |
NPI | 1053549964 |
---|---|
Provider Name | Dr. Michael Grimes |
First Address | Canonsburg, PA 15317-5442 |
Second Address | Canonsburg, PA 15317-5442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 08/10/2020 |