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NPI Code Detail

MEDICARE: DR. MARGARET ELYSE GROTHE DMD

MEDICARE: DR. MARGARET ELYSE GROTHE DMD
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
11223G0001XGeneral Practice Dentistry019.034746IL

General Provider Information

NPI Number : 1902475767
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARGARET ELYSE GROTHE DMD
Provider Business Mailing Address
First Line : 1 N MAIN ST STE A
Second Line :
City : ALGONQUIN
State : IL
Zip : 60102-2490
Country : US
Telephone Number : 224-333-2063
Fax Number :
Provider Business Practice Location Address
First Line : 63 E MAIN ST
Second Line :
City : NEW LONDON
State : OH
Zip : 44851-1233
Country : US
Telephone Number : 419-929-1544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2021
Last Update Date : 12/18/2024

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