Individual
KENNETH RUSSELL GROSSLIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD JD
Contact information
Practice address
3227 SUNSET BLVD # F, SUITE 102, WEST COLUMBIA, SC 29169-3201
(803) 724-2336
(803) 724-2317
Mailing address
3227-F SUNSET BLVD, SUITE 102, WEST COLUMBIA, SC 29169-3201
(803) 724-2336
(803) 724-2317
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101036844
VA
208VP0014X
Interventional Pain Medicine Physician
Primary
12719
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127197
—
SC
Enumeration date
05/24/2006
Last updated
07/24/2015
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