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General NPI Number Information
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NPI Number | 1639491707
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Entity Type | Organization
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Legal Business Name | THOMAS L. GROSS, MD, PC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 33 MEADOW DR
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City | DANVILLE
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State | IN
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Zip | 46122-1411
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Country | US
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Telephone | 317-745-0833
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Fax | 317-745-1203
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Provider Business Mailing Address
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Address Line | 33 MEADOW DR
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City | DANVILLE
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State | IN
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Zip | 46122-1411
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Country | US
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Telephone | 317-745-0833
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Fax | 317-745-1203
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS L GROSS
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Credential | MD
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Telephone | 317-745-0833
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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 | IN01032766
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License Number State | IN
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