Individual
MICHAEL J GROSSERODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 MED TECH PKWY, STE 280, JOHNSON CITY, TN 37604-2364
(423) 794-5550
(423) 928-0394
Mailing address
PO BOX 3889, JOHNSON CITY, TN 37602-3889
(423) 794-5550
(423) 928-0394
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26879
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3091643
—
TN
Enumeration date
06/16/2005
Last updated
03/31/2021
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