Provider Demographics
NPI:1982711701
Name:GROSSENS, MICHAEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:GROSSENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4044
Mailing Address - Country:US
Mailing Address - Phone:828-580-6753
Mailing Address - Fax:828-580-6759
Practice Address - Street 1:2201 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4044
Practice Address - Country:US
Practice Address - Phone:828-580-6753
Practice Address - Fax:828-580-6759
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
N27530039OtherMEDICARE MERCY
NC1982711701Medicaid
ON27530OtherMEDICARE GROUP NO. MERCY
MI4229429Medicaid
N27530039OtherMEDICARE MERCY