MEDICARE: BRYAN GRISCHOW 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	34007128	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	:	1811937659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN GRISCHOW DO

Provider Business Mailing Address
First Line	:	477 COOPER RD STE 440
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8055
Country	:	US
Telephone Number	:	380-898-5561
Fax Number	:	380-898-5563

Provider Business Practice Location Address
First Line	:	477 COOPER RD
Second Line	:	STE 440
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8053
Country	:	US
Telephone Number	:	380-898-5561
Fax Number	:	380-898-5563

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/11/2022

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