Provider Demographics
NPI:1386909349
Name:GROH, COREY NATHANIAL (DPM)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:NATHANIAL
Last Name:GROH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7468
Mailing Address - Fax:
Practice Address - Street 1:10122 E 10TH ST STE 230
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2664
Practice Address - Country:US
Practice Address - Phone:317-355-7120
Practice Address - Fax:317-355-9219
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000274A213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery