MEDICARE: TRACI E 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	207R00000X	Internal Medicine Physician	10085	NV
2	207R00000X	Internal Medicine Physician	ME159218	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730161951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI E GROSSMAN MD

Provider Business Mailing Address
First Line	:	4780 SW 64TH AVE STE 103
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-4400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 NW 62ND ST STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1866
Country	:	US
Telephone Number	:	954-434-1705
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	09/02/2025

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Directions to “ TRACI E GROSSMAN MD” Practice Location

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