Individual
MR. MICHAEL R GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 S 5TH ST, ENID, OK 73701-5825
(580) 249-3003
(580) 599-6447
Mailing address
PO BOX 3046, MALVERN, PA 19355-0746
(580) 249-3003
(580) 599-6447
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
10463
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013500A
—
OK
01
—
1E4684
PTAN
OK
Enumeration date
10/17/2005
Last updated
07/31/2023
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