Provider Demographics
NPI:1881693034
Name:GROSINGER, MARK E (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:GROSINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MONTGOMERY RD
Mailing Address - Street 2:#2B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7789
Mailing Address - Country:US
Mailing Address - Phone:513-891-8700
Mailing Address - Fax:513-891-8703
Practice Address - Street 1:9200 MONTGOMERY RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7789
Practice Address - Country:US
Practice Address - Phone:513-891-8700
Practice Address - Fax:513-891-8703
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004051207YX0905X
MI5101008010207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0626193Medicaid
OH0626193Medicaid
OHA16478Medicare UPIN