Provider Demographics
NPI:1578616447
Name:GROVER, SANJEEV (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:GROVER
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 1:4212 SANDY SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9700
Mailing Address - Country:US
Mailing Address - Phone:813-909-2199
Mailing Address - Fax:813-909-0669
Practice Address - Street 1:217 CRYSTAL GROVE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-6465
Practice Address - Country:US
Practice Address - Phone:813-909-2199
Practice Address - Fax:813-909-0669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics