Provider Demographics
NPI:1962515411
Name:GROGAN, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GROGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:51 CAVALIER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3966
Mailing Address - Country:US
Mailing Address - Phone:859-586-0111
Mailing Address - Fax:859-586-5109
Practice Address - Street 1:51 CAVALIER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3966
Practice Address - Country:US
Practice Address - Phone:859-586-0111
Practice Address - Fax:859-586-5109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY0739501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64219801Medicaid
KYC68611Medicare UPIN
KY64219801Medicaid