Provider Demographics
NPI:1740279660
Name:GRINDE, STEPHEN E (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:GRINDE
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 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2539
Mailing Address - Country:US
Mailing Address - Phone:615-860-5773
Mailing Address - Fax:615-860-1542
Practice Address - Street 1:2010 CHURCH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2012
Practice Address - Country:US
Practice Address - Phone:615-284-5755
Practice Address - Fax:615-284-5759
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2009-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000014954207W00000X
KY27981207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000892Medicaid
KY64772841Medicaid
A96655Medicare UPIN
TN3000892Medicaid
KY64772841Medicaid