Individual
LEONARD E GROSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
1402 S GRAND, ST LOUIS, MO 63110
(314) 577-8693
(314) 268-5478
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
207ZI0100X
Immunopathology Physician
Primary
R6J66
MO
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
R6J66
MO
Other
Enumeration date
07/20/2006
Last updated
03/18/2008
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