Provider Demographics
NPI:1407872625
Name:GROTHAUS-DAY, CYRENE D (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRENE
Middle Name:D
Last Name:GROTHAUS-DAY
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 1:335 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-2135
Mailing Address - Country:US
Mailing Address - Phone:561-320-2958
Mailing Address - Fax:
Practice Address - Street 1:1378 MOSSWOODS DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7226
Practice Address - Country:US
Practice Address - Phone:636-861-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-126419207L00000X
MO2003019558207L00000X
KY43207207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204893622Medicaid
IL036126419Medicaid
336OtherMO-BLUE SHIELD
IL256510065Medicare PIN
MO204893622Medicaid