Provider Demographics
NPI:1598840266
Name:GRINO, TIM V
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:V
Last Name:GRINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W 300 S
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-6943
Mailing Address - Country:US
Mailing Address - Phone:765-361-6940
Mailing Address - Fax:
Practice Address - Street 1:670 W 300 S
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-6943
Practice Address - Country:US
Practice Address - Phone:765-361-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications