Provider Demographics
NPI:1720466618
Name:GROTENHUIS, LEIGHE (MD)
Entity Type:Individual
Prefix:
First Name:LEIGHE
Middle Name:
Last Name:GROTENHUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEIGHE
Other - Middle Name:
Other - Last Name:LINCOLN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 NE 10TH ST # 305
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:254-502-3896
Mailing Address - Fax:
Practice Address - Street 1:11511 NE 10TH ST # 305
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:254-502-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60563101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ML60563101OtherMEDICAL LICENSE NUMBER