Provider Demographics
NPI:1598827503
Name:GROVES, DANNY G (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:G
Last Name:GROVES
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 1:11604 LITTLE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1444
Mailing Address - Country:US
Mailing Address - Phone:502-244-2992
Mailing Address - Fax:502-244-2992
Practice Address - Street 1:11604 LITTLE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1444
Practice Address - Country:US
Practice Address - Phone:502-244-2992
Practice Address - Fax:502-244-2992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15502208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000042991OtherANTHEM
KY1049941OtherPASSPORT
KY64155021Medicaid
IN100008450AOtherEDS
KY64155021Medicaid
KY1379001Medicare ID - Type Unspecified