Provider Demographics
NPI:1033423462
Name:MICHAEL E GRILLIS DO INC
Entity Type:Organization
Organization Name:MICHAEL E GRILLIS DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-355-8488
Mailing Address - Street 1:2281 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2632
Mailing Address - Country:US
Mailing Address - Phone:419-355-8488
Mailing Address - Fax:419-355-8490
Practice Address - Street 1:2281 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2632
Practice Address - Country:US
Practice Address - Phone:419-355-8488
Practice Address - Fax:419-355-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004664208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0739964Medicaid
E48128Medicare UPIN
OH0739964Medicaid