Provider Demographics
NPI:1518916311
Name:GROSSMAN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:GROSSMAN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HYLAN
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-981-2050
Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-981-2050
Mailing Address - Fax:818-981-2382
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-981-2050
Practice Address - Fax:818-981-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A750050OtherMEDI-CAL
CA00A944770OtherMEDI-CAL
CA00G532600OtherMEDI-CAL
CA1659432870OtherNPI
CAA94477OtherMEDICAL LICENSE
CACY868AOtherPTAN
CA1437172657OtherNPI
CA1780746115OtherNPI
CAA75005OtherMEDICAL LICENSE
CAG53260OtherMEDICAL LICENSE
CA1437172657OtherNPI
CACY868AOtherPTAN
CAI69256Medicare UPIN