Healthcare Provider Details

I. General information

NPI: 1659361665
Provider Name (Legal Business Name): MICHAEL ALLAN GRIM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST VAMC AUDIOLOGY #126
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

834 NW 16TH ST
OKLAHOMA CITY OK
73106-6402
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax:
Mailing address:
  • Phone: 405-270-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number266
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: