Healthcare Provider Details

I. General information

NPI: 1821063769
Provider Name (Legal Business Name): MILTON B GRIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 W 151ST ST
OLATHE KS
66061-7200
US

IV. Provider business mailing address

PO BOX 219241
KANSAS CITY MO
64121-9241
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-5511
  • Fax: 913-829-5571
Mailing address:
  • Phone: 913-829-5511
  • Fax: 913-829-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR8F92
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04 22448
License Number StateKS

VIII. Authorized Official

Name: DR. MILTON B GRIN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 913-829-5511