Healthcare Provider Details

I. General information

NPI: 1073537429
Provider Name (Legal Business Name): MICHAEL DAVID GRINKEMEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2197 PRINCESS DR
BEAVERCREEK OH
45434-8007
US

IV. Provider business mailing address

2197 PRINCESS DR
BEAVERCREEK OH
45434-8007
US

V. Phone/Fax

Practice location:
  • Phone: 240-357-5189
  • Fax:
Mailing address:
  • Phone: 240-357-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberJ0829
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberJ0829
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberJ0829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: