Provider Demographics
NPI:1033435276
Name:COOK GROTHE, BETHANY ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:COOK GROTHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 WILLOW LAKE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4464
Mailing Address - Country:US
Mailing Address - Phone:651-770-0110
Mailing Address - Fax:
Practice Address - Street 1:3555 WILLOW LAKE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-4464
Practice Address - Country:US
Practice Address - Phone:651-770-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55589207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology