MEDICARE: MICHAEL EMANUEL GRILLIS DO

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	208600000X	Surgery Physician	34004664	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1508974494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EMANUEL GRILLIS DO

Provider Business Mailing Address
First Line	:	220 COUNTY ROAD 398
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-9253
Country	:	US
Telephone Number	:	419-334-4383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2281 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-355-8488
Fax Number	:	419-355-8890

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/28/2016

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