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General NPI Number Information
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NPI Number | 1093210114
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Entity Type | Individual
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Provider Name | JONATHAN TAYLOR GROSSMAN DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2000 ROOSEVELT RD STE 201
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City | VALPARAISO
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State | IN
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Zip | 46383-2802
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Country | US
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Telephone | 219-476-7777
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Fax | 219-476-7120
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Provider Business Mailing Address
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Address Line | 833 N CLARK ST UNIT 2204
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City | CHICAGO
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State | IL
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Zip | 60610-3420
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Country | US
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Telephone | 954-673-5651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 02008130A
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License Number State | IN
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