Individual
DR. MICHAEL SAMUEL GROSSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4505 N ROCKWOOD DR, PEORIA, IL 61615-3803
(309) 589-1880
Mailing address
3602 MARQUETTE RD, PERU, IL 61354-1450
(815) 223-7400
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036128242
IL
207W00000X
Ophthalmology Physician
202629
LA
208600000X
Surgery Physician
29207
SC
208D00000X
General Practice Physician
036128242
IL
Other
Enumeration date
11/06/2006
Last updated
06/06/2023
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