Provider Demographics
NPI:1568458776
Name:GROSS, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:27401 W HIGHWAY 22 STE 125
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5934
Practice Address - Country:US
Practice Address - Phone:847-381-0388
Practice Address - Fax:847-381-0811
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036062557207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062557Medicaid
ILC43354Medicare UPIN