Provider Demographics
NPI:1417972613
Name:GROVES, LAUREN E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:E
Last Name:GROVES
Suffix:
Gender:F
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 1:43475 DALCOMA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3593
Mailing Address - Country:US
Mailing Address - Phone:586-228-2518
Mailing Address - Fax:586-228-2517
Practice Address - Street 1:43475 DALCOMA DR STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:586-228-2518
Practice Address - Fax:586-228-2517
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004766363AM0700X
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM33200Medicare ID - Type Unspecified