Provider Demographics
NPI:1699114462
Name:GROFF, DILLER BAER (MD)
Entity type:Individual
Prefix:DR
First Name:DILLER
Middle Name:BAER
Last Name:GROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 INDIAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2066
Mailing Address - Country:US
Mailing Address - Phone:502-895-0842
Mailing Address - Fax:
Practice Address - Street 1:5405 INDIAN WOODS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2066
Practice Address - Country:US
Practice Address - Phone:502-895-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY194572086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery