Provider Demographics
NPI:1891742821
Name:GROSZ, STEPHANIE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:GROSZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PROVIDENCE PARK DR E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4616
Mailing Address - Country:US
Mailing Address - Phone:251-634-1544
Mailing Address - Fax:251-634-0235
Practice Address - Street 1:600 PROVIDENCE PARK DR E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4616
Practice Address - Country:US
Practice Address - Phone:251-634-1544
Practice Address - Fax:251-634-0235
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020899207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118171Medicaid
AL000032570Medicaid
AL510-32570OtherBLUE CROSS BLUE SHIELD
AL000032570Medicaid
MS0118171Medicaid