Provider Demographics
NPI:1174695381
Name:GROSSMAN, JOHN AI (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:AI
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 N KENDALL DR STE 904E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2176
Mailing Address - Country:US
Mailing Address - Phone:305-666-2004
Mailing Address - Fax:305-271-7993
Practice Address - Street 1:8940 N KENDALL DR STE 904E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2176
Practice Address - Country:US
Practice Address - Phone:305-666-2004
Practice Address - Fax:305-271-7993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0056894174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC90166Medicare UPIN