Provider Demographics
NPI:1578834255
Name:GROTE, RYAN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:GROTE
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 1:1380 NW WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1208
Mailing Address - Country:US
Mailing Address - Phone:513-829-7133
Mailing Address - Fax:513-829-7134
Practice Address - Street 1:1380 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1208
Practice Address - Country:US
Practice Address - Phone:937-829-7133
Practice Address - Fax:513-829-7134
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011142208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168393Medicaid
OH0168393Medicaid