Individual
MICHAEL B GRILLOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1906 BLAKE AVE, GLENWOOD SPGS, CO 81601-4227
(970) 384-7140
(970) 384-7293
Mailing address
1906 BLAKE AVE, GLENWOOD SPGS, CO 81601-4227
(970) 384-7140
(970) 384-7293
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
106801
MO
207XS0106X
Orthopaedic Hand Surgery Physician
54940
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128583001
—
AR
05
—
1366423980
—
MO
01
—
431560263
TRICARE
MO
01
—
P01085134
MCR RR
MO
Enumeration date
11/10/2005
Last updated
05/21/2015
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