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Organization
SCOTT GRODMAN DPM PC
Active
Organization
SCOTT GRODMAN DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT T GRODMAN DPM (OWNER)
(313) 295-1620
Entity
Organization
Contact information
Practice address
9300 PARDEE RD, SUITE A, TAYLOR, MI 48180-3528
(313) 295-1620
(313) 295-1622
Mailing address
9300 PARDEE RD, SUITE A, TAYLOR, MI 48180-3528
(313) 295-1620
(313) 295-1622
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
001478
MI
332B00000X
Durable Medical Equipment & Medical Supplies
001478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2948227
—
MI
01
—
480H244260
BC
MI
01
—
4858213180
BC
MI
01
—
540H22790
BCBS DME
MI
Enumeration date
12/10/2007
Last updated
03/03/2017
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