Active NPI
Domenic G Grosso, D.O.
- Student in an Organized Health Care Education/Training Program
- Saint Clair Shores, MI
National Provider Identifier
1588314710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 24211 Little Mack Ave
Saint Clair Shores, MI 48080-1151 - Phone
- (586) 498-0440
- Fax
- (586) 498-0401
- NPI assigned
- Mar 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
24211 Little Mack Ave
Saint Clair Shores, MI 48080-1151
Mailing address
24211 Little Mack Ave
Saint Clair Shores, MI 48080-1151
Phone (586) 498-0440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220525003011 | OH | Order and Referring Only - Hospitalist | 5698153021 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753920000000",
"number": "1588314710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24211 LITTLE MACK AVE",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480801151",
"telephone_number": "586-498-0440",
"fax_number": "586-498-0401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24211 LITTLE MACK AVE",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480801151",
"telephone_number": "586-498-0440",
"fax_number": "586-498-0401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSO",
"first_name": "DOMENIC",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-29",
"last_updated": "2025-07-31",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.