NPIMap

Organization Active NPI

Milton J Grosenbach Edd, PC

  • Psychologist
  • Metamora, MI
National Provider Identifier
1821135831
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301003782 Issued in MI
Legal business name
MILTON J GROSENBACH EDD, PC
Practice address
3562 S Lapeer Rd
Suite F
Metamora, MI 48455-8998
Phone
(810) 678-8898
Fax
(810) 678-8808
NPI assigned
Jan 31, 2007
Last updated
Jun 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Milton James Grosenbach Jr., EDD PCNPI 1851392310
Title
Dr Owner
Phone
(810) 678-8898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 6301003782 MI Primary
Exclusive Provider Organization 302F00000X 4101005216 MI

Addresses

Primary practice location

3562 S Lapeer Rd
Suite F
Metamora, MI 48455-8998

Mailing address

3562 S Lapeer Rd
Suite F
Metamora, MI 48455-8998
Phone (810) 678-8898

Other identifiers 4

IdentifierTypeStateIssuer
0M43200OtherMIMEDICARE ID
OD41119OtherMIBLUE CARE NETWORK
0D41076OtherMIBLUE CROSS BLUE SHIELD
620G44601OtherMIHEALTH PLUS

Other names 1

  • The Centre Other name

National Provider Directory

National Provider Directory

Locations

202 E Nepessing St
Lapeer, MI 48446
Phone (810) 667-9099

3562 S Lapeer Rd
Ste F
Metamora, MI 48455
Phone (810) 212-1277

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1821135831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3562 S LAPEER RD",
            "address_2": "SUITE F",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484558998",
            "telephone_number": "810-678-8898",
            "fax_number": "810-678-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3562 S LAPEER RD",
            "address_2": "SUITE F",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484558998",
            "telephone_number": "810-678-8898",
            "fax_number": "810-678-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILTON J GROSENBACH EDD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2016-06-27",
        "status": "A",
        "authorized_official_last_name": "GROSENBACH",
        "authorized_official_first_name": "MILTON",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DR  OWNER",
        "authorized_official_telephone_number": "810-678-8898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "EDD PC"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301003782",
            "primary": true
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "4101005216",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "0M43200",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "OD41119",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0D41076",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLUS",
            "identifier": "620G44601",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Centre",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Metamora, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.