DR. MICHAEL JACK GROSSMAN (NPI# 1942367008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942367008 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL JACK GROSSMAN |
| Credential | M.D. |
| Practice Address |
24432 Muirlands Blvd Suite 111 Lake Forest CA 92630-3939 |
| Practice Telephone | 9497707301 |
| Practice Fax Number | 9497700634 |
| Mailing Telephone | 9497707501 |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2008-03-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | G33405 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICAL LICENSE | G33405 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407217540 | Michael Grossman | Chiropractor | 425 Washington St Ste 100, San Francisco, CA 94111-2345 | 2016-03-17 |
| 1215016662 | Michael Samuel Grossman | Ophthalmology | 4505 N Rockwood Dr, Peoria, IL 61615-3803 | 2006-11-06 |
| 1417055286 | Michael Alan Grossman | Dentist | 6246 East Pima Street, Suite 100, Tucson, AZ 85712-3157 | 2006-09-20 |
| 1659488997 | Michael Grossman | Internal Medicine | 550 E Van Buren St, Building 3, Room 3261, Phoenix, AZ 85004-2230 | 2006-08-24 |
| 1225011786 | Michael R. Grossman | Podiatrist | 121 Coulter Ave, Suite 109, Ardmore, PA 19003-2418 | 2005-11-29 |
| 1831188218 | Michael J Grossman | Obstetrics & Gynecology | 565 Turnpike St, Suite 74, North Andover, MA 01845-5922 | 2005-10-18 |
| 1245239102 | Michael Grossman | Emergency Medicine | 4505 20th Ave, Valley, AL 36854-3542 | 2005-07-21 |
| 1467455816 | Michael Paul Grossman | Obstetrics & Gynecology | 38a Old Sparrowbush Road, Latham, NY 12110 | 2005-05-31 |
| 1760810857 | Michael Grossman | Nurse Practitioner | 960 Johnson Ferry Rd, Ste 500, Atlanta, GA 30342-1631 | 2013-10-29 |
| 1265594758 | Michael S Grossman | Specialist | 901 Lakeshore Drive, Ishpeming, MI 49849 | 2006-12-14 |
| Street Address |
24432 MUIRLANDS BLVD SUITE 111 |
| City | LAKE FOREST |
| State | CA |
| Zip Code | 92630-3939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871573543 | John Sands Brizendine | Dentist | 24432 Muirlands Blvd, Suite #209, Lake Forest, CA 92630-3939 | 2006-01-19 |
| 1346774445 | Inland Psychiatric Medical Group, Inc. | Psychologist | 24432 Muirlands Blvd, Sutie 131, Lake Forest, CA 92630-3939 | 2017-04-14 |
| 1336412998 | Darren Terry | Physical Therapist | 24432 Muirlands Blvd, Ste. 201, Lake Forest, CA 92630-3939 | 2012-02-13 |
| 1558646620 | James L. Kay, D.o., P.C. | Clinic/Center | 24432 Muirlands Blvd, Suite 111, Lake Forest, CA 92630-3939 | 2011-10-20 |
| 1962616656 | James Leon Kay | Pediatrics | 24432 Muirlands Blvd, Suite 111, Lake Forest, CA 92630-3939 | 2007-05-10 |
| 1568565653 | Anthony Ernest Follico | Dentist | 24432 Muirlands Blvd, Suite 211, Lake Forest, CA 92630 | 2006-09-06 |
| 1205802089 | Azin Meshkinpour | Dermatology | 24432 Muirlands Blvd, Suite 219, Lake Forest, CA 92630-3939 | 2006-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194370338 | Ashlee Nicole-morton Sourapas | Midwife | 22672 Lambert Street, Suite 611, Lake Forest, CA 92630 | 2019-08-05 |
| 1134784879 | Scott Mach Enterprises | Custodial Care Facility | 23235 Cavanaugh Road, Lake Forest, CA 92630 | 2019-05-08 |
| 1992368930 | James Daniel Ticorat | Pharmacist | 25051 Calle Arenal, Lake Forest, CA 92630 | 2019-04-16 |
| 1770058349 | Tara L Anderson | Physician Assistant | 22365 El Toro Rd Unit 310, Lake Forest, CA 92630 | 2018-10-10 |
| 1659846855 | Song W. Jung. Dds. Inc | Dentist | 23361 El Toro Rd, Ste 105, Lake Forest, CA 92630 | 2018-10-04 |
| 1326520867 | Katherine Marie Billings | Speech-Language Pathologist | 25454 Navajo, Lake Forest, CA 92630 | 2018-08-31 |
| 1205339611 | Orange County Physiotherapy Services, P.C. | Physical Therapist | 22821 Aspan St., #100, Lake Forest, CA 92630 | 2018-03-12 |
| 1295245587 | Tara Rasta | Chiropractor | 22672 Lambert St Suite 620, Olsen Chiropractic, Lake Forest, CA 92630 | 2017-10-02 |
| 1750800132 | Jessica Aguilar | Marriage & Family Therapist | 21153 Calle De Paseo, Lake Forest, CA 92630 | 2017-09-16 |
| 1275072589 | Anhtu Wu | Pharmacist | 23182 Vista Way, Lake Forest, CA 92630 | 2017-02-20 |
| Find all providers in zip 92630 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386802940 | Health and Wellness Center, Inc. | Family Medicine | 23672 Birtcher Rd., Unit A, Lake Forest, CA 92630-1711 | 2008-05-29 |
| 1043374473 | Chyle E Beaird | Family Medicine | 24401 Muirlands Blvd Ste C, Lake Forest, CA 92630-3949 | 2006-12-20 |
| 1700952827 | Adel Boutros | Family Medicine | 22611 Lake Forest Dr, Lake Forest, CA 92630-1700 | 2006-11-28 |
| 1053405506 | Mohammed Mahmood Ali | Family Medicine | 23672 Birtcher Dr, Unit A, Lake Forest, CA 92630-1711 | 2006-10-02 |
| 1285747402 | California Emergency Physicians | Family Medicine | 22855 Lake Forest Dr, # A, Lake Forest, CA 92630-1656 | 2006-08-15 |
| 1982613253 | Gonzalo Flores Ruiz | Family Medicine | 22741 Lambert St, Suite1607, Lake Forest, CA 92630-1617 | 2006-08-05 |
| 1720009152 | Carol Ann Barnes-blanks | Family Medicine | 23672 Birtcher Dr Unit A, Lake Forest, CA 92630-1711 | 2006-07-21 |
| 1538190954 | Moulton Family Medical, Inc. | Family Medicine | 22611 Lake Forest Dr. #c-4, Lake Forest, CA 92630 | 2006-07-05 |
| 1306838909 | Mary M Koumas | Family Medicine | 24401 Muirlands Blvd, Suite #a, Lake Forest, CA 92630-3948 | 2005-08-19 |
| 1598394686 | Vituity - Urgent Care Services PC | Family Medicine | 22855 Lake Forest Dr Ste A, Lake Forest, CA 92630-1656 | 2020-04-02 |
| Find all providers in LAKE FOREST | ||||
| City | LAKE FOREST |
| Zip Code | 92630 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.