Individual
DR. TIMOTHY M GRONLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 N HILLSIDE, WICHITA, KS 67214-4910
(316) 962-2900
(316) 962-7815
Mailing address
551 N. HILLSIDE, SUITE 320, WICHITA, KS 67214-4926
(316) 685-1367
(316) 685-9388
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-30825
KS
2085R0202X
Diagnostic Radiology Physician
0430825
KS
2085R0204X
Vascular & Interventional Radiology Physician
Primary
0430825
KS
2085U0001X
Diagnostic Ultrasound Physician
04-30825
KS
2085U0001X
Diagnostic Ultrasound Physician
0430825
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105646
BCBS
KS
05
—
200385940C
—
KS
Enumeration date
07/19/2006
Last updated
11/20/2023
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