Provider Demographics
NPI:1144379363
Name:GROCH, JOHN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:GROCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 STUART CT
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4629
Mailing Address - Country:US
Mailing Address - Phone:630-832-5326
Mailing Address - Fax:815-741-7591
Practice Address - Street 1:333 MADISON
Practice Address - Street 2:ST JOSEPH MEDICAL CENTER
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8233
Practice Address - Country:US
Practice Address - Phone:815-741-7200
Practice Address - Fax:815-741-7591
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360732662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36073266Medicaid
L89177Medicare ID - Type Unspecified
IL36073266Medicaid