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General NPI Number Information
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NPI Number | 1720007404
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Entity Type | Individual
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Provider Name | TIMOTHY M GRONLIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 550 N HILLSIDE
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City | WICHITA
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State | KS
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Zip | 67214-4910
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Country | US
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Telephone | 316-962-2900
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Fax | 316-962-7815
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Provider Business Mailing Address
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Address Line | 551 N. HILLSIDE SUITE 320
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City | WICHITA
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State | KS
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Zip | 67214-4926
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Country | US
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Telephone | 316-685-1367
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Fax | 316-685-9388
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0430825
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0430825
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 04-30825
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 0430825
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 04-30825
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License Number State | KS
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