MEDICARE: KILEY GROEBNER

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1184346116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILEY GROEBNER

Provider Business Mailing Address
First Line	:	2920 N 82ND ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-9737
Country	:	US
Telephone Number	:	480-313-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	4512 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3604
Country	:	US
Telephone Number	:	602-954-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	03/27/2024

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Directions to “ KILEY GROEBNER ” Practice Location

Language	Start Address	Practice Location

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