Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 56562 | MN |
NPI | 1245598275 |
---|---|
Provider Name | Heather Grothe |
First Address | Duluth, MN 55805-1951 |
Second Address | Saint Paul, MN 55106-2824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 20/12/2016 |