Provider Demographics
NPI:1427163492
Name:GROGAN, TERENCE M (DO)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:M
Last Name:GROGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TERENCE
Other - Middle Name:MICHAEL
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1550 E STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-8293
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:426 S ALABAMA ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-3301
Practice Address - Country:US
Practice Address - Phone:317-528-2489
Practice Address - Fax:317-528-3770
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017356207Q00000X
WI48857207Q00000X
VA102050142207Q00000X
IN02005401A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine