Individual
JOHN RAY GROENEVELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
440 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4631
(906) 776-9040
(906) 774-7279
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
406754
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1994486
—
MI
05
—
31491800
—
WI
01
—
P01692639
RAILROAD MEDICARE
MI
Enumeration date
07/21/2005
Last updated
03/17/2018
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