1609857531 NPI number — DR. MICHAEL R GRIESMER DDS

Table of content: DR. MICHAEL R GRIESMER DDS (NPI 1609857531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609857531 NPI number — DR. MICHAEL R GRIESMER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIESMER
Provider First Name:
MICHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609857531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 BOARDMAN-CANFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-533-3400
Provider Business Mailing Address Fax Number:
330-533-2700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6285 YOUNGSTOWN WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-505-9224
Provider Business Practice Location Address Fax Number:
330-965-9594
Provider Enumeration Date:
11/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  17887 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0587413 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".