MEDICARE: ALEXANDRA GROB D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	5101020085	MI
2	207N00000X	Dermatology Physician	25MB09882600	NJ
3	390200000X	Student in an Organized Health Care Education/Training Program	5101020085	MI
4	207N00000X	Dermatology Physician	OS17608	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588927354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GROB D.O.

Provider Business Mailing Address
First Line	:	905 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2113
Country	:	US
Telephone Number	:	813-336-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2113
Country	:	US
Telephone Number	:	813-336-7688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	12/26/2024

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