Provider Demographics
NPI:1205915154
Name:WILLIAM H. GROS, MD,SC
Entity type:Organization
Organization Name:WILLIAM H. GROS, MD,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-390-1240
Mailing Address - Street 1:512 W BURLINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2221
Mailing Address - Country:US
Mailing Address - Phone:630-390-1240
Mailing Address - Fax:630-390-1247
Practice Address - Street 1:512 W BURLINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2221
Practice Address - Country:US
Practice Address - Phone:630-390-1240
Practice Address - Fax:630-390-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL716520Medicare ID - Type Unspecified