Provider Demographics
NPI:1811937659
Name:GRISCHOW, BRYAN (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GRISCHOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 COOPER RD STE 440
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8055
Mailing Address - Country:US
Mailing Address - Phone:380-898-5561
Mailing Address - Fax:380-898-5563
Practice Address - Street 1:477 COOPER RD
Practice Address - Street 2:STE 440
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8053
Practice Address - Country:US
Practice Address - Phone:380-898-5561
Practice Address - Fax:380-898-5563
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007128208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2120770Medicaid
OH020046446OtherRAILROAD MEDICARE INDIVIDUAL NUMBER
OH0885465OtherMEDICARE PTAN
OHDD5151OtherRR MEDICARE GROUP NUMBER
OH020046446OtherRAILROAD MEDICARE INDIVIDUAL NUMBER