Provider Demographics
NPI:1053592899
Name:MICHAEL G. GRIMES MD, INC
Entity type:Organization
Organization Name:MICHAEL G. GRIMES MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-869-9598
Mailing Address - Street 1:791 WHITE POND DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4202
Mailing Address - Country:US
Mailing Address - Phone:330-869-9598
Mailing Address - Fax:
Practice Address - Street 1:791 WHITE POND DR
Practice Address - Street 2:SUITE C
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4202
Practice Address - Country:US
Practice Address - Phone:330-869-9598
Practice Address - Fax:330-869-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077014G208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP01311Medicare PIN