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General NPI Number Information
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NPI Number | 1366979007
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Entity Type | Individual
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Provider Name | JORDAN GRILLIOT D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 3130 N COUNTY ROAD 25A STE 116
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City | TROY
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State | OH
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Zip | 45373-1337
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Country | US
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Telephone | 937-335-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 NORTHBRIDGE TRL
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City | TROY
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State | OH
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Zip | 45373-4667
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Country | US
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Telephone | 937-626-3110
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Fax |
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 330890
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 34.016569
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License Number State | OH
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