Healthcare Provider Details

I. General information

NPI: 1689054553
Provider Name (Legal Business Name): CALEB W GROTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 09/02/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE 1B
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8233
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6062
  • Fax: 314-454-5054
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number2020013859
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2020013859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: