Provider Demographics
NPI:1346345055
Name:LINDA A. GROENE MD PA
Entity Type:Organization
Organization Name:LINDA A. GROENE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GROENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-0062
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-772-0062
Mailing Address - Fax:954-772-0845
Practice Address - Street 1:2021 E COMMERCIAL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3754
Practice Address - Country:US
Practice Address - Phone:954-772-0062
Practice Address - Fax:954-772-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41488207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03759ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLK7299Medicare PIN
FLD50819Medicare UPIN