Individual
MR. NICHOLAS DAVID GROTJOHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5881 NW 16TH PL APT 219, SUNRISE, FL 33313-4776
(954) 297-7369
Mailing address
11110 W OAKLAND PARK BLVD STE 376, SUNRISE, FL 33351-6808
(954) 297-7369
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
W473363
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H1019-023
—
FL
Enumeration date
05/22/2023
Last updated
08/14/2023
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