Individual
KATHLEEN LOUISE GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 335-0185
(573) 335-0793
Mailing address
721 N SUNSET BLVD, CAPE GIRARDEAU, MO 63701-4532
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036086294
IL
207L00000X
Anesthesiology Physician
Primary
2005008372
MO
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
2005008372
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
2005008372
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086294
—
IL
01
—
105181
BLUE CROSS BLUE SHIELD
MO
05
—
207336405
—
MO
01
—
697359
HEALTHLINK
—
Enumeration date
08/30/2006
Last updated
11/24/2020
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