Grossman, Michael Jack

Grossman, Michael Jack is an sole proprietor health care provider with primary practice located at 24432 Muirlands Blvd Suite 111, Lake Forest CA 92630-3939. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Grossman, Michael Jack can be contacted via phone (949) 770-7301.

Contact Information

Primary practice address
24432 Muirlands Blvd Suite 111 Lake Forest CA 92630-3939
Phone: (949) 770-7301
Fax: (949) 770-0634
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G33405 California

Profile Details

NPI number 1942367008
LBN Legal business name Grossman, Michael Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 1st, 2007
Last updated Mar 27th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942367008 NPPES
California Other G33405 MEDICAL LICENSE

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