Provider Demographics
NPI:1780687871
Name:GROSSMAN, STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 E LIVINGSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1967
Mailing Address - Country:US
Mailing Address - Phone:614-239-9444
Mailing Address - Fax:614-239-1080
Practice Address - Street 1:4068 GANTZ RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4816
Practice Address - Country:US
Practice Address - Phone:614-539-0200
Practice Address - Fax:614-317-7392
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001586213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165851Medicaid
OH0372413Medicare PIN
OHH347110Medicare PIN
OH0372413Medicare PIN
OH4231853Medicare PIN
OHP01473906Medicare PIN
OH480028546OtherRAILROAD MEDICARE
OH4231852Medicare PIN