Provider Demographics
NPI:1407802770
Name:GROTE, JON J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:J
Last Name:GROTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2231
Mailing Address - Country:US
Mailing Address - Phone:513-793-3933
Mailing Address - Fax:
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-793-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS57836Medicare UPIN
OHGRPA01741Medicare PIN