Provider Demographics
NPI:1821098427
Name:GROSSMAN, SHELDON L (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:L
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 1:400 E RED BRIDGE RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4035
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:SUITE 314
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000365213ES0103X
KS12-00116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00741012OtherBLUE CROSS BLUE SHIELD
MOT42395Medicare UPIN
MO0002754Medicare PIN