Provider Demographics
NPI:1912949918
Name:GRIMM, JOHN K (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:GRIMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 NEW HAVEN ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-2780
Mailing Address - Country:US
Mailing Address - Phone:513-981-5852
Mailing Address - Fax:513-367-8031
Practice Address - Street 1:10450 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2780
Practice Address - Country:US
Practice Address - Phone:513-921-4227
Practice Address - Fax:513-367-8031
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250437Medicaid
OH4230533Medicare PIN
OH0250437Medicaid
OHP00458769Medicare PIN