Individual
DEREK I GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5365 HIDDEN GLEN DR, TRAVERSE CITY, MI 49684-7042
(989) 621-5014
Mailing address
PO BOX 107, TRAVERSE CITY, MI 49685-0107
(231) 922-9270
(231) 922-9271
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101011248
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4892891
—
MI
Enumeration date
07/03/2006
Last updated
04/12/2021
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