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Individual

CHARLES G GROEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01068054A
IN
2085R0001X
Radiation Oncology Physician
036085244
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000726585
ANTHEM PROVIDER NUMBER
IN
05
036085244
IL
05
201034800
IN
Enumeration date
09/30/2005
Last updated
11/04/2011
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