Healthcare Provider Details

I. General information

NPI: 1801058334
Provider Name (Legal Business Name): MICHAEL JAMES GRAU JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8783
  • Fax: 513-475-7698
Mailing address:
  • Phone: 513-245-3072
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30026049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: