Provider Demographics
NPI:1336122175
Name:GRIMES, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:GRIMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 EAST STATE STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3634
Mailing Address - Country:US
Mailing Address - Phone:330-596-6560
Mailing Address - Fax:
Practice Address - Street 1:4774 MUNSON ST NW
Practice Address - Street 2:SUITE 401
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3634
Practice Address - Country:US
Practice Address - Phone:330-754-4431
Practice Address - Fax:330-777-5499
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077014G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256311Medicaid
OHH38479Medicare UPIN
OH2256311Medicaid