Individual
DR. ANTHONY M GRIMALDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036053826
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203979055
MEDICARE PTAN
IL
01
—
BLUE CROSS BLUE SHIE
21626252
IL
Enumeration date
01/16/2007
Last updated
12/03/2015
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