Provider Demographics
NPI:1467637959
Name:SHELDON L GROSSMAN DPMPC
Entity Type:Organization
Organization Name:SHELDON L GROSSMAN DPMPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPMPC
Authorized Official - Phone:816-942-1795
Mailing Address - Street 1:400 E RED BRIDGE RD
Mailing Address - Street 2:314
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4031
Mailing Address - Country:US
Mailing Address - Phone:816-942-1795
Mailing Address - Fax:816-942-0782
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4035
Practice Address - Country:US
Practice Address - Phone:816-942-1795
Practice Address - Fax:816-942-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000365213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00741012OtherBLULE CROSS BLUE SHIELD
MO1821098427OtherNPI-INDIVIDUAL
MO0002754Medicare PIN
MOT42395Medicare UPIN