Provider Demographics
NPI:1740238005
Name:GROF, MICHAEL W (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GROF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 44TH ST. SUITE 207
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-0981
Mailing Address - Country:US
Mailing Address - Phone:616-243-9898
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE
Practice Address - Street 2:SUITE 207
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-243-9898
Practice Address - Fax:616-243-4296
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010095382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1354145115OtherBCBSM
MI2639034Medicaid
MIE49661Medicare UPIN
MI5414511Medicare ID - Type Unspecified