Provider Demographics
NPI:1972358968
Name:GROZLEKOV, STEFAN
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:GROZLEKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14188 WALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7465
Mailing Address - Country:US
Mailing Address - Phone:727-768-9256
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN STE 20400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4600
Practice Address - Country:US
Practice Address - Phone:615-936-3218
Practice Address - Fax:615-936-3533
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program