Provider Demographics
NPI:1750648275
Name:GROSS, SARAH KATHERINE STORM (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KATHERINE STORM
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2590 6TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-4339
Practice Address - Country:US
Practice Address - Phone:319-249-6422
Practice Address - Fax:319-249-6822
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-45046207N00000X
MN25424207N00000X
IAR-9372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology