Provider Demographics
NPI:1568493328
Name:GROSS, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GROSS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:502-473-4067
Mailing Address - Fax:502-473-4077
Practice Address - Street 1:1918 HIKES LANE, SUITE 102
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NEWBURG, LLC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-473-4067
Practice Address - Fax:502-473-4067
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-24
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Provider Licenses
StateLicense IDTaxonomies
KYTP627207R00000X
KY40264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine