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General NPI Number Information
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NPI Number | 1306069513
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Entity Type | Organization
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Legal Business Name | JAMES A GROSS MD SC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 130 S IL ROUTE 83
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1620
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Country | US
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Telephone | 847-856-3800
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Fax | 847-856-3803
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Provider Business Mailing Address
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Address Line | 130 S IL ROUTE 83
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1620
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Country | US
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Telephone | 847-856-3800
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Fax | 847-856-3803
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES A GROSS
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Credential | MD
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Telephone | 847-856-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036072198
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License Number State | IL
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