Basic Information
| Provider Information | |||||||||
| NPI: | 1740390806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEGROOT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 LUDINGTON ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067861356 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 LUDINGTON ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498294212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067861356 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 39721 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 4301051444 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.