Healthcare Provider Details

I. General information

NPI: 1902828007
Provider Name (Legal Business Name): MICHAEL J GROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY SUITE 410
BEVERLY HILLS CA
90210-5192
US

IV. Provider business mailing address

9675 BRIGHTON WAY SUITE 410
BEVERLY HILLS CA
90210-5192
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-2525
  • Fax: 310-274-5530
Mailing address:
  • Phone: 310-274-2525
  • Fax: 310-274-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG58694
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG58694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: