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NPI Code Detail

MEDICARE: BRUCE GLENN GROSSMAN MD

MEDICARE: BRUCE GLENN 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
1174400000XSpecialist036060298IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036060298OTHERILSTATE LICENSE NUMBER

General Provider Information

NPI Number : 1982668158
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE GLENN GROSSMAN MD
Provider Business Mailing Address
First Line : 1000 GRAND CANYON PKWY
Second Line : SUITE 301
City : HOFFMAN ESTATES
State : IL
Zip : 60169-1705
Country : US
Telephone Number : 847-882-5888
Fax Number : 847-882-5951
Provider Business Practice Location Address
First Line : 1000 GRAND CANYON PKWY
Second Line : SUITE 301
City : HOFFMAN ESTATES
State : IL
Zip : 60169-1705
Country : US
Telephone Number : 847-882-5888
Fax Number : 847-882-5951
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 10/13/2014

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Directions to “ BRUCE GLENN GROSSMAN MD” Practice Location

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