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General NPI Number Information
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NPI Number | 1528867504
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Entity Type | Individual
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Provider Name | EVAN ZACHARY GROSS PHD
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Gender | Male
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 250 W EISENHOWER PKWY STE 190
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City | ANN ARBOR
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State | MI
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Zip | 48103-6934
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Country | US
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Telephone | 734-961-7187
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Fax |
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Provider Business Mailing Address
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Address Line | 21546 GREGORY ST
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City | DEARBORN
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State | MI
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Zip | 48124-3006
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Country | US
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Telephone | 201-403-4977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301018995
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License Number State | MI
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