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General NPI Number Information
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NPI Number | 1730167883
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Entity Type | Individual
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Provider Name | MICHAEL JAMES GROSSELL DO
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Gender | Male
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Dates
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Enumeration Date | 01/07/2006
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 305 W COLLEGE AVE SUITE A
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City | SHELBY
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State | NC
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Zip | 28152-8111
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Country | US
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Telephone | 704-434-9686
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Fax | 704-434-9618
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Provider Business Mailing Address
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Address Line | 373 DARK CORNER RD
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City | RUTHERFORDTON
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State | NC
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Zip | 28139-6757
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Country | US
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Telephone | 704-418-1210
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Fax | 704-434-9618
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9501262
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License Number State | NC
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