Provider Demographics
NPI:1629069661
Name:GROSS, STEVEN NORMAN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:NORMAN
Last Name:GROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE R2009
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-0050
Mailing Address - Fax:734-712-0055
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE R2009
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-0050
Practice Address - Fax:734-712-0055
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG008589208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250007864OtherRAILROAD MEDICARE
MI2713427Medicaid
MI250H110020OtherBCBS OF MICHIGAN
MI250H110020OtherBCBS OF MICHIGAN
MIB45994Medicare UPIN
MI2713427Medicaid