Provider Demographics
NPI:1669497590
Name:GROETSCH, JOSHUA MARK (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
Last Name:GROETSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4324 VETERANS BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-883-7690
Mailing Address - Fax:504-455-7864
Practice Address - Street 1:4324 VETERANS BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-883-7690
Practice Address - Fax:504-455-7864
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA025627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1045276Medicaid
LA1045276Medicaid
LA4K1977627Medicare PIN
LA157603Medicare UPIN