Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 16669 | OH |
NPI | 1043202690 |
---|---|
Provider Name | Dr. Michael James Grau |
First Address | Cincinnati, OH 45209-1948 |
Second Address | Cincinnati, OH 45209-1948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T54074 | (02) |