Individual
KELLY GROTT
Active
Individual
KELLY GROTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01083529A
IN
207L00000X
Anesthesiology Physician
11020205A
IN
207R00000X
Internal Medicine Physician
MED-RES-LIC-58231
MT
208VP0014X
Interventional Pain Medicine Physician
Primary
01083529A
IN
208VP0014X
Interventional Pain Medicine Physician
036156733
IL
Other
Enumeration date
03/30/2017
Last updated
08/07/2025
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