Provider Demographics
NPI:1083606750
Name:GRIMMETT, MICHAEL RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RALPH
Last Name:GRIMMETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 BURNS RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4328
Mailing Address - Country:US
Mailing Address - Phone:561-691-3937
Mailing Address - Fax:561-691-3992
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:SUITE 209
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-691-3937
Practice Address - Fax:561-691-3992
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0073787207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41956YMedicare ID - Type Unspecified
F22947Medicare UPIN