Basic Information
| Provider Information | |||||||||
| NPI: | 1568493328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024734067 | ||||||||
| FaxNumber: | 5024734077 | ||||||||
| Practice Location | |||||||||
| Address1: | 1918 HIKES LANE, SUITE 102 | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL NEWBURG, LLC | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024734067 | ||||||||
| FaxNumber: | 5024734067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TP627 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 40264 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.