Healthcare Provider Details

I. General information

NPI: 1497612337
Provider Name (Legal Business Name): DYLAN GRUBBS LMCH-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

V. Phone/Fax

Practice location:
  • Phone: 888-714-1927
  • Fax:
Mailing address:
  • Phone: 888-714-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number88002483A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: