Provider Demographics
NPI:1790841278
Name:GROTKE, HAL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:LOUIS
Last Name:GROTKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2350 BUHNE ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3238
Practice Address - Country:US
Practice Address - Phone:707-443-4593
Practice Address - Fax:707-269-7116
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85346Medicare UPIN