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NPI Code Detail

MEDICARE: ELIZABETH TOEBBE GROUT PA-C

MEDICARE: ELIZABETH TOEBBE GROUT PA-C
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 AssistantPA1953KY
2363A00000XPhysician Assistant5601008168MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053713511
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH TOEBBE GROUT PA-C
Provider Business Mailing Address
First Line : 2888 E LONG LAKE RD STE 105
Second Line :
City : TROY
State : MI
Zip : 48085-3700
Country : US
Telephone Number : 859-801-3679
Fax Number :
Provider Business Practice Location Address
First Line : 2888 E LONG LAKE RD STE 105
Second Line :
City : TROY
State : MI
Zip : 48085-3700
Country : US
Telephone Number : 248-689-1330
Fax Number : 248-689-6424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2014
Last Update Date : 07/21/2022

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Directions to “ ELIZABETH TOEBBE GROUT PA-C” Practice Location

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