Provider Demographics
NPI:1902897648
Name:GROYSMAN, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:GROYSMAN
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:855-227-4230
Mailing Address - Fax:812-926-1668
Practice Address - Street 1:1640 FLOSSIE DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-8424
Practice Address - Country:US
Practice Address - Phone:855-227-4230
Practice Address - Fax:812-926-1668
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200507590Medicaid
INP00716119Medicare PIN
IN172580DDMedicare PIN
IN200507590Medicaid
INM400069793Medicare PIN