Provider Demographics
NPI:1093210114
Name:GROSSMAN, JONATHAN TAYLOR (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TAYLOR
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:833 N CLARK ST UNIT 2204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3420
Mailing Address - Country:US
Mailing Address - Phone:954-673-5651
Mailing Address - Fax:
Practice Address - Street 1:2000 ROOSEVELT RD STE 201
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2802
Practice Address - Country:US
Practice Address - Phone:219-476-7777
Practice Address - Fax:219-476-7120
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02008130A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology