Healthcare Provider Details

I. General information

NPI: 1245224153
Provider Name (Legal Business Name): STEVEN JOHN GROUSE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH WAY DR
POTOSI MO
63664-1420
US

IV. Provider business mailing address

9221 LURLINE DR
SAINT LOUIS MO
63126-2125
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-5451
  • Fax:
Mailing address:
  • Phone: 314-849-7392
  • Fax: 314-849-7392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000726
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: