Provider Demographics
NPI:1164478327
Name:GROSS, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN322732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN063803000Medicaid
MN1017995OtherPREFERRED ONE
MN596678OtherAMERICA'S PPO
WI31821600Medicaid
MNHP44291OtherHEALTHPARTNERS
MN300112531OtherRAILROAD MEDICARE MN
MN105624OtherUCARE
MN85D32GROtherBLUE CROSS
MN96D77GROtherBLUE CROSS BLUE SHIELD
IA1927343Medicaid
MNF26031Medicare UPIN
IA1927343Medicaid
MN105624OtherUCARE