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NPI Code Detail

MEDICARE: HEIDI GABRIELLE GRODMAN

MEDICARE: HEIDI GABRIELLE GRODMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1265299507
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI GABRIELLE GRODMAN
Provider Business Mailing Address
First Line : 1400 S DOBSON RD
Second Line :
City : MESA
State : AZ
Zip : 85202-4707
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 S DOBSON RD
Second Line :
City : MESA
State : AZ
Zip : 85202-4707
Country : US
Telephone Number : 480-412-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2024
Last Update Date : 01/05/2026

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Directions to “ HEIDI GABRIELLE GRODMAN ” Practice Location

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