Healthcare Provider Details

I. General information

NPI: 1508228750
Provider Name (Legal Business Name): JAMES HOWARD BRODY ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43097 WOODWARD AVE STE 202
BLOOMFIELD TOWNSHIP MI
48302-5043
US

IV. Provider business mailing address

43097 WOODWARD AVE STE 202
BLOOMFIELD HILLS MI
48302-5043
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-4505
  • Fax: 248-253-0347
Mailing address:
  • Phone: 248-334-4505
  • Fax: 248-253-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.138777
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA11833500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number4301512511
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301512511
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: