Provider Demographics
NPI:1356467526
Name:GROVE, MICHAEL K (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:GROVE
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 LAKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4352
Mailing Address - Country:US
Mailing Address - Phone:330-833-0531
Mailing Address - Fax:330-833-2917
Practice Address - Street 1:418 LAKE AVE NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4352
Practice Address - Country:US
Practice Address - Phone:330-833-0531
Practice Address - Fax:330-833-2917
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1281237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist