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General NPI Number Information
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NPI Number | 1366423980
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Entity Type | Individual
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Provider Name | MICHAEL B GRILLOT M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 1906 BLAKE AVE
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City | GLENWOOD SPGS
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State | CO
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Zip | 81601-4227
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Country | US
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Telephone | 970-384-7140
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Fax | 970-384-7293
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Provider Business Mailing Address
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Address Line | 1906 BLAKE AVE
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City | GLENWOOD SPGS
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State | CO
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Zip | 81601-4227
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Country | US
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Telephone | 970-384-7140
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Fax | 970-384-7293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 106801
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 54940
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License Number State | CO
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