Provider Demographics
NPI:1043310188
Name:GROEBNER, NATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:GROEBNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN488982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300005559Medicare PIN
MN300004103Medicare ID - Type Unspecified
MNI67711Medicare UPIN
MN300004901Medicare PIN