Healthcare Provider Details

I. General information

NPI: 1083051171
Provider Name (Legal Business Name): RANDALL GROUT M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 W 38TH ST
INDIANAPOLIS IN
46254-2919
US

IV. Provider business mailing address

1101 W 10TH ST
INDIANAPOLIS IN
46202-4800
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-3838
  • Fax:
Mailing address:
  • Phone: 317-274-9000
  • Fax: 317-274-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01076974A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: