Individual
JEFFREY S GROOTHUIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2030 W BOULEVARD, KOKOMO, IN 46902-6079
(765) 454-0200
Mailing address
2030 W BOULEVARD, KOKOMO, IN 46902-6079
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01045118A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100090
—
IN
Enumeration date
02/24/2006
Last updated
09/22/2022
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