Healthcare Provider Details

I. General information

NPI: 1730144254
Provider Name (Legal Business Name): PATRICIA A CONTRERAS-GROVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA A CONTRERAS MD

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S HEATHWOOD DR
MARCO ISLAND FL
34145-5026
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-394-0693
  • Fax: 239-642-2321
Mailing address:
  • Phone: 239-658-3064
  • Fax: 239-658-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: