Provider Demographics
NPI:1780795302
Name:DEGROOT, IRENE (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:DEGROOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9293
Mailing Address - Country:US
Mailing Address - Phone:989-673-3191
Mailing Address - Fax:989-673-0064
Practice Address - Street 1:2000 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9293
Practice Address - Country:US
Practice Address - Phone:989-673-3191
Practice Address - Fax:989-673-0064
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010608102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE85929OtherUPIN
MI2607901142OtherBLUE CROSS BLUE SHIELD