Healthcare Provider Details

I. General information

NPI: 1346345055
Provider Name (Legal Business Name): LINDA A. GROENE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E COMMERCIAL BLVD STE 201
FORT LAUDERDALE FL
33308-3754
US

IV. Provider business mailing address

6405 N FEDERAL HWY STE. 102
FORT LAUDERDALE FL
33308-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-0062
  • Fax: 954-772-0845
Mailing address:
  • Phone: 954-772-0062
  • Fax: 954-772-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME41488
License Number StateFL

VIII. Authorized Official

Name: DR. LINDA ANN GROENE
Title or Position: PRESIDENT
Credential: MD
Phone: 954-772-0062