Provider Demographics
NPI:1770271710
Name:GRILLAS, KONSTANTINOS (MD)
Entity type:Individual
Prefix:MR
First Name:KONSTANTINOS
Middle Name:
Last Name:GRILLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRINITY HEALTH LAVONIA HOSPITAL
Mailing Address - Street 2:36475 FIVE MILE RD
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TRINITY HEALTH ACADEMIC FAMILY MEDICINE-NORTHWEST LIVON
Practice Address - Street 2:37595 SEVEN MILE RD., SUITE 210
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-853-5690
Practice Address - Fax:734-430-9388
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty