Healthcare Provider Details

I. General information

NPI: 1801126958
Provider Name (Legal Business Name): THOMAS GROSCH, MD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S. BUENA VISTA, SUITE 320
BURBANK CA
91505-4556
US

IV. Provider business mailing address

191 S. BUENA VISTA, SUITE 320
BURBANK CA
91505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 818-559-9727
  • Fax: 818-559-5514
Mailing address:
  • Phone: 818-559-9727
  • Fax: 818-559-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG82164
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS M GROSCH
Title or Position: PRESIDENT
Credential: M.D. F.A.C.S.
Phone: 818-559-9727