Individual
GRANT D. COMNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
18101 LORAIN AVENUE CLEVELAND CLINIC - FAIRVIEW HOSPITA, EMERGENCY SERVICES, CLEVELAND, OH 44111-5612
(216) 476-7312
Mailing address
18101 LORAIN AVENUE CLEVELAND CLINIC - FAIRVIEW HOSPITA, EMERGENCY SERVICES, CLEVELAND, OH 44111-5612
(216) 476-7312
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34003752C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0865916
—
OH
01
—
942460636277
CARESOURCE
OH
01
—
P00194513
MEDICARE TRAVELERS RR-GA
OH
Enumeration date
05/28/2006
Last updated
06/29/2018
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