Active NPI
Dwight A Grotte, MD
- Immunopathology Physician
- Minneapolis, MN
National Provider Identifier
1376502005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Immunopathology Physician
- License
- 31398
- Practice address
- 6500 Excelsior Blvd
Minneapolis, MN 55426-4702 - Phone
- (952) 993-5290
- NPI assigned
- Mar 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Immunopathology Physician | 207ZI0100X | 31398 | MN | Primary |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 31398 | MN | |
| Chemical Pathology Physician | 207ZP0104X | 31398 | MN |
Addresses
Primary practice location
6500 Excelsior Blvd
Minneapolis, MN 55426-4702
Mailing address
PO Box 385760
Bloomington, MN 55438-5760
Phone (952) 944-0970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31398 | MN | MD | Chemical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1376502005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 385760",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554385760",
"telephone_number": "952-944-0970",
"fax_number": "952-944-1761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 EXCELSIOR BLVD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554264702",
"telephone_number": "952-993-5290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROTTE",
"first_name": "DWIGHT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207ZI0100X",
"taxonomy_group": "",
"desc": "Pathology, Immunopathology",
"state": "MN",
"license": "31398",
"primary": true
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MN",
"license": "31398",
"primary": false
},
{
"code": "207ZP0104X",
"taxonomy_group": "",
"desc": "Pathology, Chemical Pathology",
"state": "MN",
"license": "31398",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.