MEDICARE: DR. MICHAEL PAUL GROSSMAN MD

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
1	207VE0102X	Reproductive Endocrinology Physician	38293	KY
2	207VE0102X	Reproductive Endocrinology Physician	239545	NY

General Provider Information

NPI Number	:	1467455816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PAUL GROSSMAN MD

Provider Business Mailing Address
First Line	:	92 PHEASANT RDG
Second Line	:
City	:	NISKAYUNA
State	:	NY
Zip	:	12309-2517
Country	:	US
Telephone Number	:	518-374-3541
Fax Number	:

Provider Business Practice Location Address
First Line	:	38A OLD SPARROWBUSH ROAD
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110
Country	:	US
Telephone Number	:	518-690-0700
Fax Number	:	518-724-5757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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