Grosslight, Kenneth Russell
Grosslight, Kenneth Russell is an sole proprietor health care provider with primary practice located at 3227 Sunset Blvd # F Suite 102, West Columbia SC 29169-3201. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Grosslight, Kenneth Russell can be contacted via phone (803) 724-2336.Contact Information
Primary practice address
3227 Sunset Blvd # F Suite 102
West Columbia SC 29169-3201
Phone: (803) 724-2336
Fax: (803) 724-2317
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 0101036844 | Virginia |
| Allopathic & Osteopathic Physicians / Interventional Pain Medicine | 208VP0014X | 12719 | South Carolina |
Profile Details
| NPI number | 1194770115 |
|---|---|
| LBN Legal business name | Grosslight, Kenneth Russell |
| Credentials | MD JD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 24th, 2006 |
| Last updated | Jul 24th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194770115 | NPPES |
| South Carolina | MEDICAID | 127197 |
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