Healthcare Provider Details

I. General information

NPI: 1174695381
Provider Name (Legal Business Name): JOHN A.I. GROSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 904E
MIAMI FL
33176-2176
US

IV. Provider business mailing address

8940 N KENDALL DR STE 904E
MIAMI FL
33176-2176
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-2004
  • Fax: 305-271-7993
Mailing address:
  • Phone: 305-666-2004
  • Fax: 305-271-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 0056894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: