Individual
SCOTT T GRODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
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
5901001478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H22790
BC DME
MI
05
—
2948227
—
MI
01
—
48-0H244260
BC
MI
01
—
4858213180
BC
MI
Enumeration date
09/08/2005
Last updated
05/10/2017
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