MEDICARE: MARK R GRUBB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	35-081466-G	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00064176	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134111768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK R GRUBB MD

Provider Business Mailing Address
First Line	:	150 SPRINGSIDE DR
Second Line	:	SUITE B 225
City	:	AKRON
State	:	OH
Zip	:	44333-2468
Country	:	US
Telephone Number	:	330-865-6956
Fax Number	:	330-865-6972

Provider Business Practice Location Address
First Line	:	300 ALLEN BRADLEY DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-6130
Country	:	US
Telephone Number	:	330-865-6956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	06/15/2024

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Directions to “ MARK R GRUBB MD” Practice Location

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