Provider Demographics
NPI:1811908478
Name:GROSSMAN, BRENDA J (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:GROSSMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5641
Mailing Address - Fax:314-362-0369
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 4E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-5641
Practice Address - Fax:314-362-0369
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO105103207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205389703Medicaid
IL$$$$$$$$$Medicaid