Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD15990 | ME |
NPI | 1003885708 |
---|---|
Provider Name | Heinrich H.m. Grube |
First Address | Scarborough, ME 04074-9701 |
Second Address | Augusta, ME 04330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 28/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043861 | ANTHEM (01) | |
283940099 | (05) | ME |
30207223 | (05) | NH |
3064022 | AETNA (01) | |
G86356 | (02) | ME |