Provider Demographics
NPI:1730475104
Name:GROTHOUS, HEATHER FAY (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:FAY
Last Name:GROTHOUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1215 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1811
Mailing Address - Country:US
Mailing Address - Phone:517-353-8122
Mailing Address - Fax:517-432-9414
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-353-8122
Practice Address - Fax:517-432-9414
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019479207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine