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General NPI Number Information
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NPI Number | 1730161951
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Entity Type | Individual
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Provider Name | TRACI E GROSSMAN MD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2122 NW 62ND ST STE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1866
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Country | US
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Telephone | 954-434-1705
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 SW 64TH AVE STE 103
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City | DAVIE
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State | FL
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Zip | 33314-4400
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10085
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME159218
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License Number State | FL
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