Provider Demographics
NPI:1689086373
Name:ROSS, PHILIP (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:400 MACK AVENUE
Mailing Address - Street 2:SUITE 2 WEST - CREDENTIALING DEPT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-448-9006
Mailing Address - Fax:
Practice Address - Street 1:27351 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3487
Practice Address - Country:US
Practice Address - Phone:248-967-7795
Practice Address - Fax:248-967-7794
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2021-02-04
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Provider Licenses
StateLicense IDTaxonomies
MI51010210382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology