Individual
MICHAEL P GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2929 S ELLIS AVE, CHICAGO, IL 60616-3395
(312) 791-2000
Mailing address
2929 S ELLIS AVE, CHICAGO, IL 60616-3395
(312) 791-2000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915653
BLUE SHIELD ILLINOIS
IL
Enumeration date
08/14/2006
Last updated
10/10/2007
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