Provider Demographics
NPI:1730167883
Name:GROSSELL, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:GROSSELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:373 DARK CORNER RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-6757
Mailing Address - Country:US
Mailing Address - Phone:704-418-1210
Mailing Address - Fax:704-434-9618
Practice Address - Street 1:305 W COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8111
Practice Address - Country:US
Practice Address - Phone:704-434-9686
Practice Address - Fax:704-434-9618
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-07
Last Update Date:2015-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9501262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1007POtherBCBS IND
NC891007PMedicaid
NC1007POtherBCBS IND