Individual
JEREMY M GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9204
(262) 329-1000
(262) 329-1001
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
64690
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048498
—
WI
05
—
1205254067
—
WI
Enumeration date
03/30/2014
Last updated
10/10/2023
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