Provider Demographics
NPI:1184998700
Name:MICHAEL ALAN GROSSMAN MD PC
Entity type:Organization
Organization Name:MICHAEL ALAN GROSSMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-756-9604
Mailing Address - Street 1:4505 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3542
Mailing Address - Country:US
Mailing Address - Phone:334-756-9604
Mailing Address - Fax:334-756-9606
Practice Address - Street 1:4505 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3542
Practice Address - Country:US
Practice Address - Phone:334-756-9604
Practice Address - Fax:334-756-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35434207RC0200X
ALMD7925207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000181145EOtherMEDICAID
AL009929055Medicaid
AL51007808OtherBCBSAL
AL51007808OtherBCBSAL