Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 6731091-1205 | UT |
NPI | 1083827455 |
---|---|
Provider Name | Dr. Kenneth Frederick Grossmann |
First Address | Salt Lake City, UT 84102-1971 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 10/12/2021 |