Provider Demographics
NPI:1770577629
Name:GROVES, MITZI M (DO)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:M
Last Name:GROVES
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:15101 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:KS
Practice Address - Zip Code:66223-3154
Practice Address - Country:US
Practice Address - Phone:913-681-8866
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
KS05-31268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI34703Medicare UPIN
KS553A00002Medicare PIN