Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35062416 | OH |
Y | 208200000X | Surgeon | 35062416 | OH |
Y | 208600000X | Surgeon | 35062416 | OH |
N | 2086S0129X | Vascular Surgeon | 35062416 | OH |
NPI | 1043265382 |
---|---|
Provider Name | Gary M Grosel |
First Address | Westlake, OH 44145-1964 |
Second Address | Downers Grove, IL 60515-7915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 12/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017945 | (05) | OH |
F79950 | (02) |