Healthcare Provider Details

I. General information

NPI: 1407217540
Provider Name (Legal Business Name): MICHAEL GROSSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WASHINGTON ST STE 100
SAN FRANCISCO CA
94111-2345
US

IV. Provider business mailing address

425 WASHINGTON ST STE 100
SAN FRANCISCO CA
94111-2345
US

V. Phone/Fax

Practice location:
  • Phone: 415-788-8700
  • Fax: 415-788-8702
Mailing address:
  • Phone: 415-788-8700
  • Fax: 415-788-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number33523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: