Provider Demographics
NPI:1033150677
Name:GROSS, RICHARD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-399-8550
Mailing Address - Fax:402-399-8455
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 224
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-399-8550
Practice Address - Fax:402-399-8455
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE14104207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14914OtherMIDLANDS CHOICE
NE09-01135OtherSHARE ADVANTAGE/LAKESIDE
NE47063010113Medicaid
NE02647OtherBCBS OF NEBRASKA
NE09-00178OtherSHARE ADVANTAGE/MERCY RD
IA0922500Medicaid
NE02647OtherBCBS OF NEBRASKA
NED92370Medicare UPIN
NE202938058Medicare PIN