Provider Demographics
NPI:1942692058
Name:MELVIN M. GROSSMAN, M.D.
Entity Type:Organization
Organization Name:MELVIN M. GROSSMAN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-962-6333
Mailing Address - Street 1:4700 SHERIDAN ST
Mailing Address - Street 2:SUITE U
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3420
Mailing Address - Country:US
Mailing Address - Phone:954-962-6333
Mailing Address - Fax:954-963-2442
Practice Address - Street 1:4700 SHERIDAN ST
Practice Address - Street 2:SUITE U
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3420
Practice Address - Country:US
Practice Address - Phone:954-962-6333
Practice Address - Fax:954-963-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME00416702084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL204628OtherAVMED
FL94283OtherBCBS
FL066156200Medicaid
FL130019943OtherRAILROAD MEDICARE
FLD63186Medicare UPIN
FL066156200Medicaid