Healthcare Provider Details

I. General information

NPI: 1346373313
Provider Name (Legal Business Name): DAVID G. GROSS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

IV. Provider business mailing address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8989
  • Fax: 219-756-6389
Mailing address:
  • Phone: 219-769-8989
  • Fax: 219-756-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number02001570A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: