Provider Demographics
NPI:1467526582
Name:ROSS, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:3500 FIFTEEN MILE ROAD
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-977-9936
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:3500 FIFTEEN MILE ROAD
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-977-9936
Practice Address - Fax:586-268-8158
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044928207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
010H262530OtherBLUE CROSS-BLUE CROSS
MI301419010Medicaid
MR044928OtherCOMMERCIAL-COMMERCIAL NUMBER
MR044928OtherCHAMPUS-CHAMPUS
MIMR044928OtherBCBS
MI105201834Medicaid
MIMR044928OtherBCBS
MI0M92460032Medicare PIN
0H26253073Medicare ID - Type Unspecified