Provider Demographics
NPI:1144200650
Name:GRIMA, LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:GRIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4222
Mailing Address - Country:US
Mailing Address - Phone:734-240-8430
Mailing Address - Fax:734-240-8495
Practice Address - Street 1:650 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4222
Practice Address - Country:US
Practice Address - Phone:734-240-8430
Practice Address - Fax:734-240-8495
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4475128Medicaid
MI1144200650Medicaid
MI0805800561OtherBCBSM
MI0805800561OtherBCBSM
MI4475128Medicaid