Provider Demographics
NPI:1902828007
Name:GROTH, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9675 BRIGHTON WAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5192
Mailing Address - Country:US
Mailing Address - Phone:310-274-2525
Mailing Address - Fax:310-274-5530
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5192
Practice Address - Country:US
Practice Address - Phone:310-274-2525
Practice Address - Fax:310-274-5530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG58694207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1800085000OtherRAILROAD MEDICARE
CA00G586940OtherBLUE SHIELD
G58694Medicare ID - Type Unspecified
1800085000OtherRAILROAD MEDICARE