Provider Demographics
NPI:1730144254
Name:CONTRERAS-GROVES, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CONTRERAS-GROVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3064
Mailing Address - Fax:239-658-3175
Practice Address - Street 1:40 S HEATHWOOD DR
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5026
Practice Address - Country:US
Practice Address - Phone:239-394-0693
Practice Address - Fax:239-642-2321
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC283847Medicaid
FL265834800Medicaid
SC283847Medicaid
FL29088ZMedicare PIN