MEDICARE: DR. TERENCE M GROGAN DO

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	207Q00000X	Family Medicine Physician	5101017356	MI
2	207Q00000X	Family Medicine Physician	48857	WI
3	207Q00000X	Family Medicine Physician	102050142	VA
4	207Q00000X	Family Medicine Physician	02005401A	IN

General Provider Information

NPI Number	:	1427163492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERENCE M GROGAN DO

Provider Business Mailing Address
First Line	:	1550 E STATE ROAD 44
Second Line	:
City	:	CONNERSVILLE
State	:	IN
Zip	:	47331-8293
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 S ALABAMA ST STE 100
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-3301
Country	:	US
Telephone Number	:	317-528-2489
Fax Number	:	317-528-3770

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/20/2020

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