Provider Demographics
NPI:1639303290
Name:DAVID GRISCHKAN MD INC
Entity Type:Organization
Organization Name:DAVID GRISCHKAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRISCHKAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-591-1420
Mailing Address - Street 1:24025 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-591-1420
Mailing Address - Fax:216-591-1424
Practice Address - Street 1:24025 COMMERCE PARK ROAD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-591-1420
Practice Address - Fax:216-591-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA78878Medicare UPIN