Provider Demographics
NPI:1831184738
Name:GROSMAN, DAREN D (MD)
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:D
Last Name:GROSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAREN
Other - Middle Name:
Other - Last Name:GROSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:801 N FLAMINGO RD STE 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1019
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-443-4747
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0088312207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010744900Medicaid
FLH65283Medicare UPIN