Basic Information
| Provider Information | |||||||||
| NPI: | 1285677906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUBE | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24701 EUCLID AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441171714 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVENUE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168447700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35082636 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | 35082636 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1015709030001 | 05 | PA | MEDICAID | 000000221210 | 01 | OH | UNISON | OTHER | 2421632 | 01 | OH | BCMH | OTHER | 745909 | 01 | OH | BUCKEYE | OTHER | 363590 | 01 | OH | WELLCARE | OTHER | 000000526047 | 01 | OH | ANTHEM | OTHER | 2421632 | 05 | OH | MEDICAID | 7789768 | 01 | OH | AETNA | OTHER |