Healthcare Provider Details

I. General information

NPI: 1174562912
Provider Name (Legal Business Name): ROBERT D GRIMSHAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 MAIN ST
BIRCH RUN MI
48415-9461
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-7001
  • Fax: 989-624-8993
Mailing address:
  • Phone: 989-583-4337
  • Fax: 989-583-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013846
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: