# SCOTT GRODMAN DPM PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750564050
- **Authorized official:** SCOTT T GRODMAN DPM (OWNER)
- **Authorized official phone:** (313) 295-1620

## Contact information

- **Practice address:** 9300 PARDEE RD, SUITE A, TAYLOR, MI 48180-3528
- **Practice address phone:** (313) 295-1620
- **Practice address fax:** (313) 295-1622
- **Mailing address:** 9300 PARDEE RD, SUITE A, TAYLOR, MI 48180-3528
- **Mailing address phone:** (313) 295-1620
- **Mailing address fax:** (313) 295-1622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213E00000X | Podiatrist | 001478 | MI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 001478 | MI | — |

## Other

- **Enumeration date:** 12/10/2007
- **Last updated:** 03/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2948227 | — | MI |
| 01 | — | 480H244260 | BC | MI |
| 01 | — | 4858213180 | BC | MI |
| 01 | — | 540H22790 | BCBS DME | MI |