Provider Demographics
NPI:1720049950
Name:GROWNEY, SEAN THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:GROWNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 BALSAM HILL CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3811
Mailing Address - Country:US
Mailing Address - Phone:616-405-3226
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12525207L00000X
MI5101013847208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6264209OtherCIGNA
MI5184976-11Medicaid
MI4552951-11Medicaid
MI4654209-11Medicaid
MI557010545OtherBLUE CROSS BLUE SHIELD
7000144081OtherPRIORITY HEALTH
P00209804OtherRAILROAD MEDICARE
01795OtherAETNA
134899901OtherUS DEPARTMENT OF LABOR
MI4654209-11Medicaid
MI4552951-11Medicaid