Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 84514 | OH |
NPI | 1356332357 |
---|---|
Provider Name | Dr. Jeremy Michael Groll |
First Address | Centerville, OH 45459-4816 |
Second Address | Centerville, OH 45459-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 10/08/2016 |