MEDICARE: ANA P GROESCHEL M.D.

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	2084N0400X	Neurology Physician	41380	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1417951435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA P GROESCHEL M.D.

Provider Business Mailing Address
First Line	:	3601 MINNESOTA DR STE 200
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55435-5202
Country	:	US
Telephone Number	:	612-879-1000
Fax Number	:	612-879-9116

Provider Business Practice Location Address
First Line	:	11091 ULYSSES STREET NE
Second Line	:	SUITE 100
City	:	BLAINE
State	:	MN
Zip	:	55434
Country	:	US
Telephone Number	:	612-879-1000
Fax Number	:	612-879-0722

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/16/2023

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