Provider Demographics
NPI:1184610206
Name:GROSE, CHARLES F (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:GROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2270
Mailing Address - Fax:319-356-4855
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2270
Practice Address - Fax:319-356-4855
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA246032080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0222372Medicaid
IA22237OtherWELLMARK BCBS
IA22237OtherWELLMARK BCBS
A02556Medicare UPIN
IA0222372Medicaid