Provider Demographics
NPI:1780778704
Name:GROSS, ARNOLD SCOTT (DPM)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:SCOTT
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-646-6882
Mailing Address - Fax:248-646-7677
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 235
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-646-6882
Practice Address - Fax:248-646-7677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG000942213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2109403Medicaid
MI0F32399OtherBLLUE CROSS/BLUE SHIELD
MI0F32399OtherBLLUE CROSS/BLUE SHIELD