Provider Demographics
NPI:1922008945
Name:ROSS, ALAN JOSEPH (MD)
Entity Type:Individual
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First Name:ALAN
Middle Name:JOSEPH
Last Name:ROSS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:29355 NORTHWESTERN HWY
Mailing Address - Street 2:120
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1053
Mailing Address - Country:US
Mailing Address - Phone:248-577-3522
Mailing Address - Fax:248-577-3526
Practice Address - Street 1:750 STEPHENSON HWY
Practice Address - Street 2:235 BBC
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1103
Practice Address - Country:US
Practice Address - Phone:248-577-3522
Practice Address - Fax:248-577-3526
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2010-01-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301036707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI409812010Medicaid
MID85213Medicare UPIN
MI409812010Medicaid