Individual
MR. GLENN CURTIS GROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
7905 CALUMET AVE, MUNSTER, IN 46321-2549
(219) 836-5800
(219) 836-3048
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5601004940
MI
363A00000X
Physician Assistant
Primary
10000975A
IN
363A00000X
Physician Assistant
5601004940
MI
Other
Enumeration date
10/26/2006
Last updated
05/07/2024
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