Provider Demographics
NPI:1447242938
Name:GROSSMAN, JOEL STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:STEVEN
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8089
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-8089
Mailing Address - Country:US
Mailing Address - Phone:239-643-1155
Mailing Address - Fax:239-643-9816
Practice Address - Street 1:1441 RIDGE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4211
Practice Address - Country:US
Practice Address - Phone:239-643-1155
Practice Address - Fax:239-643-9816
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME783202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC76124Medicare UPIN
FL52285Medicare ID - Type Unspecified