Provider Demographics
NPI:1083696827
Name:DEGROOTE, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:DEGROOTE
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:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-1449
Mailing Address - Country:US
Mailing Address - Phone:303-425-9245
Mailing Address - Fax:303-425-1378
Practice Address - Street 1:3885 UPHAM ST
Practice Address - Street 2:STE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4880
Practice Address - Country:US
Practice Address - Phone:303-425-9245
Practice Address - Fax:303-425-1378
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO31125207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311257Medicaid
COF67233Medicare UPIN
CO803060Medicare ID - Type Unspecified
CO01311257Medicaid
COP00350825Medicare PIN