Provider Demographics
NPI:1346373313
Name:GROSS, DAVID G (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:303 W 89TH AVE
Mailing Address - Street 2:SUITE E4
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6294
Mailing Address - Country:US
Mailing Address - Phone:219-769-8989
Mailing Address - Fax:219-756-6389
Practice Address - Street 1:303 W 89TH AVE
Practice Address - Street 2:SUITE E4
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6294
Practice Address - Country:US
Practice Address - Phone:219-769-8989
Practice Address - Fax:219-756-6389
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02001570A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100475590Medicaid
IN000000092837OtherANTHEM
IN000000092837OtherANTHEM