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General NPI Number Information
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NPI Number | 1659865079
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Entity Type | Individual
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Provider Name | JOHN C GROTBERG MD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1701 SENATE BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1239
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Country | US
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Telephone | 317-962-5820
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Fax | 317-962-3916
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 314-996-5000
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01093052A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 01093052A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2022034948
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 01093052A
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License Number State | IN
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