Individual
DENISE R GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 436-4658
Mailing address
20 PRESTIGE PLZ, SUITE 100, MIAMISBURG, OH 45342-5354
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
35058663
OH
207P00000X
Emergency Medicine Physician
Primary
35058663
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0704547
MEDICARE PTAN
OH
01
—
0704548
MEDICARE PTAN
OH
05
—
0834315
—
OH
Enumeration date
12/28/2005
Last updated
03/07/2013
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