Individual
JASON R GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
611 E DOUGLAS RD STE 101, MISHAWAKA, IN 46545-1464
(574) 335-6800
(574) 335-0772
Mailing address
707 CEDAR ST STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07001058A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
36.003447
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000591888
BCBS BMG MAIN STREET
IN
01
—
000000591890
BCBS BMG LAPORTE
IN
01
—
000000592921
BCBS BMG SCHWARTZ
IN
01
—
000000592923
BCBS BMG IRELAND
IN
01
—
000000630279
BCBS BMG PORTAGE
IN
01
—
000000710624
BCBS BMG BREMEN
IN
05
—
200912030
—
IN
01
—
738460026
MEDICARE PIN
IN
01
—
IN1933041
MEDICARE PIN
IN
01
—
P00656770
RR MEDICARE
IN
Enumeration date
04/17/2008
Last updated
07/15/2022
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