Individual
FRED L GROOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1414 W FAIR AVE STE 242, MARQUETTE, MI 49855-5406
(906) 449-2900
(906) 449-2975
Mailing address
301 EXPLORER ST, GWINN, MI 49841-2813
(906) 346-4924
(906) 346-6474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28880-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31367800
—
WI
01
—
521823
MEDICARE PART A - CLINIC
WI
01
—
521824
MEDICARE A MOBIL UNIT
WI
Enumeration date
06/08/2005
Last updated
04/14/2021
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