Individual
MICHAEL D GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 N AMIDON AVE, STE 100, WICHITA, KS 67203-2125
(316) 832-9024
(316) 832-9478
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9667
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-25925
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719199
MEDICARE
—
05
—
100289990D
—
KS
Enumeration date
04/25/2006
Last updated
05/08/2014
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