Organization
DR. MICHAEL H. GROUSD DDS MA LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA L MCMANAMON (MANAGER)
(847) 367-4190
Entity
Organization
Contact information
Practice address
1 E PHILLIP RD, SUITE 101, VERNON HILLS, IL 60061-1858
(847) 367-4190
(847) 367-5010
Mailing address
1 E PHILLIP RD, SUITE 101, VERNON HILLS, IL 60061-1858
(847) 367-4190
(847) 367-5010
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80022385
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/22/2007
Last updated
12/07/2007
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