Provider Demographics
NPI:1174562912
Name:GRIMSHAW, ROBERT D (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:GRIMSHAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-4337
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:8470 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9461
Practice Address - Country:US
Practice Address - Phone:989-624-7001
Practice Address - Fax:989-624-8993
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4532064Medicaid
MI4532064Medicaid
MIH43128Medicare UPIN