Healthcare Provider Details

I. General information

NPI: 1861552960
Provider Name (Legal Business Name): MEGAN GROTEFEND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN EWING LEWIS M.D.

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 JACKSON STREET
SOUTH FORK CO
81154
US

IV. Provider business mailing address

52 JACKSON STREET
SOUTH FORK CO
81154
US

V. Phone/Fax

Practice location:
  • Phone: 719-873-5494
  • Fax: 719-873-5488
Mailing address:
  • Phone: 719-873-5494
  • Fax: 719-837-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42313
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number98-315
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: