Healthcare Provider Details

I. General information

NPI: 1134394281
Provider Name (Legal Business Name): MICHAEL J. GROGAN M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CAVALIER BLVD SUITE 230
FLORENCE KY
41042-3966
US

IV. Provider business mailing address

51 CAVALIER BLVD SUITE 230
FLORENCE KY
41042-3966
US

V. Phone/Fax

Practice location:
  • Phone: 859-586-0111
  • Fax:
Mailing address:
  • Phone: 859-586-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21980
License Number StateKY

VIII. Authorized Official

Name: MICHAEL JOSEPH GROGAN
Title or Position: OWNER
Credential: M.D.
Phone: 859-586-0111