Individual
RYAN TIMOTHY GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1818 CAREW ST STE 320, FORT WAYNE, IN 46805-4764
(260) 373-5890
(260) 422-8444
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01071541A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201095340
—
IN
Enumeration date
04/29/2010
Last updated
03/24/2023
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