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General NPI Number Information
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NPI Number | 1922675693
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Entity Type | Individual
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Provider Name | JARED MATHEW GROOTWASSINK MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 14001 RIDGEDALE DR STE 200
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City | MINNETONKA
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State | MN
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Zip | 55305-1747
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Country | US
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Telephone | 952-249-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19640
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9640
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Country | US
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Telephone | 217-545-8000
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Fax | 217-545-7958
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 78992
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 125.077905
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License Number State | IL
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