Provider Demographics
NPI:1639263130
Name:GROSS, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2510 WESTCHESTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3512
Mailing Address - Country:US
Mailing Address - Phone:718-517-3030
Mailing Address - Fax:718-517-3031
Practice Address - Street 1:2510 WESTCHESTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3512
Practice Address - Country:US
Practice Address - Phone:718-517-3030
Practice Address - Fax:718-517-3031
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-08-10
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Provider Licenses
StateLicense IDTaxonomies
NY155707208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070039Medicaid
NYA60713Medicare UPIN
NY01070039Medicaid