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General NPI Number Information
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NPI Number | 1184618811
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Entity Type | Individual
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Provider Name | SCOTT T GRODMAN DPM
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Gender | Male
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 9300 PARDEE RD SUITE A
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City | TAYLOR
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State | MI
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Zip | 48180-3528
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Country | US
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Telephone | 313-295-1620
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Fax | 313-295-1622
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Provider Business Mailing Address
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Address Line | 9300 PARDEE RD SUITE A
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City | TAYLOR
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State | MI
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Zip | 48180-3528
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Country | US
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Telephone | 313-295-1620
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Fax | 313-295-1622
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001478
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License Number State | MI
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