Healthcare Provider Details

I. General information

NPI: 1154303501
Provider Name (Legal Business Name): TODD E GRIME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 CORNELL RD
CINCINNATI OH
45249
US

IV. Provider business mailing address

3979 HICKORY HOLLOW DR
HAMILTON OH
45013-9049
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-3933
  • Fax: 513-793-8299
Mailing address:
  • Phone: 716-713-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35073014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: