Basic Information
| Provider Information | |||||||||
| NPI: | 1235109737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROARK | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 18768 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060037254 | 01 | RAILROAD MEDICARE | OTHER | 4624195 | 01 | AETNA | OTHER | 51049408 | 01 | AL | BCBS | OTHER | 111844 | 05 | AL | MEDICAID | 111891 | 05 | AL | MEDICAID | 51049407 | 01 | AL | BCBS | OTHER | 51598608 | 01 | AL | BCBS | OTHER | 111846 | 05 | AL | MEDICAID | 25-10051 | 01 | UNITED HEALTHCARE | OTHER | 51049241 | 01 | AL | BCBS | OTHER | P00744666 | 01 | AL | RAILROAD MEDICARE | OTHER | 111470 | 05 | AL | MEDICAID | 51049242 | 01 | AL | BCBS | OTHER | 51049243 | 01 | AL | BCBS | OTHER | 111888 | 05 | AL | MEDICAID | 3035375 | 01 | TN | BCBS | OTHER | 51033803 | 01 | AL | BCBS | OTHER | 000033803 | 05 | AL | MEDICAID | 111468 | 05 | AL | MEDICAID |