Basic Information
| Provider Information | |||||||||
| NPI: | 1093129405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROVER-MANTHEY | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 W MICHIGAN ST | ||||||||
| Address2: | FESLER HALL, ROOM 318 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172748282 | ||||||||
| FaxNumber: | 3172783909 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554151623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128733000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2014 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 11018141A | IN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 63546 | MN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.