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General NPI Number Information
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NPI Number | 1083051171
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Entity Type | Individual
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Provider Name | RANDALL GROUT M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 5515 W 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2919
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Country | US
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Telephone | 317-880-3838
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4800
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Country | US
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Telephone | 317-274-9000
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Fax | 317-274-9305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01076974A
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License Number State | IN
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