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NPI Code Detail

MEDICARE: JAMES ALAN GROGAN PA

MEDICARE:   JAMES ALAN GROGAN  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601001722MI
2363AM0700XMedical Physician Assistant5601001722MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1382516038OTHERMIGROUP PRACTICE TAX ID NUM

General Provider Information

NPI Number : 1003932476
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES ALAN GROGAN PA
Provider Business Mailing Address
First Line : 5730 MAIN ST
Second Line :
City : LEXINGTON
State : MI
Zip : 48450-8800
Country : US
Telephone Number : 810-696-2088
Fax Number : 810-696-2088
Provider Business Practice Location Address
First Line : 5730 MAIN ST
Second Line :
City : LEXINGTON
State : MI
Zip : 48450-8800
Country : US
Telephone Number : 810-696-2088
Fax Number : 810-696-2088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 10/07/2016

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Directions to “ JAMES ALAN GROGAN PA” Practice Location

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