Provider Demographics
NPI:1497733851
Name:GROSS, JAMES ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-0040
Mailing Address - Country:US
Mailing Address - Phone:847-856-3800
Mailing Address - Fax:847-856-3803
Practice Address - Street 1:205 COMMERCE DR
Practice Address - Street 2:SUITE B
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1646
Practice Address - Country:US
Practice Address - Phone:847-856-3800
Practice Address - Fax:847-856-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036072198207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603690OtherBLUE CROSS BLUE SHIELD IL
ILIL5556001Medicare PIN
ILIL6153Medicare UPIN
IL31603690OtherBLUE CROSS BLUE SHIELD IL