Provider Demographics
NPI:1194987057
Name:GROVER, PRIYANKA (MBBS)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8397 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7307
Mailing Address - Country:US
Mailing Address - Phone:954-998-1887
Mailing Address - Fax:954-440-0902
Practice Address - Street 1:8397 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7307
Practice Address - Country:US
Practice Address - Phone:954-998-1887
Practice Address - Fax:954-440-0902
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12641390200000X
FLME1188962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4820492OtherAETNA
FL014225500Medicaid
FL5456376OtherCIGNA
FLP01397023OtherRR MEDICARE
FL14Z24OtherBCBS
FL014225500Medicaid