Provider Demographics
NPI:1871603563
Name:GROTHAUS, STEVEN ALAN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:GROTHAUS
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 1:4879 SR 68 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357
Mailing Address - Country:US
Mailing Address - Phone:937-465-8090
Mailing Address - Fax:937-465-8191
Practice Address - Street 1:4879 SR 68 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357
Practice Address - Country:US
Practice Address - Phone:937-465-8090
Practice Address - Fax:937-465-8191
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005168G207RG0100X
OH34.005168208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845581Medicaid
OH0845581Medicaid
F04867Medicare UPIN