Provider Demographics
NPI:1114110335
Name:GROSSBERG, SIDNEY E (MD)
Entity Type:Individual
Prefix:PROF
First Name:SIDNEY
Middle Name:E
Last Name:GROSSBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8701 W WATERTOWN PLANK RD # CCN2542
Mailing Address - Street 2:MEDICAL COLLEGE OF WISCONSIN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3548
Mailing Address - Country:US
Mailing Address - Phone:414-456-8105
Mailing Address - Fax:414-456-6566
Practice Address - Street 1:8701 W WATERTOWN PLANK RD # CCN2542
Practice Address - Street 2:MEDICAL COLLEGE OF WISCONSIN
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3548
Practice Address - Country:US
Practice Address - Phone:414-456-8105
Practice Address - Fax:414-456-6566
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
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Provider Licenses
StateLicense IDTaxonomies
WIWI-15815-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine