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NPI Code Detail

MEDICARE: BRANDON PATRICK GROSS LLMSW

MEDICARE: BRANDON PATRICK GROSS LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801106497MI

General Provider Information

NPI Number : 1740812767
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON PATRICK GROSS LLMSW
Provider Business Mailing Address
First Line : 1005 CHAMPION ST
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4921
Country : US
Telephone Number : 906-360-3617
Fax Number :
Provider Business Practice Location Address
First Line : 102 W WASHINGTON ST STE 106
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4350
Country : US
Telephone Number : 906-228-8881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2020
Last Update Date : 02/07/2020

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Directions to “ BRANDON PATRICK GROSS LLMSW” Practice Location

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