MEDICARE: STUART IRVING GROSS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME0015954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023004660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART IRVING GROSS MD

Provider Business Mailing Address
First Line	:	1355 NE 171ST ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2732
Country	:	US
Telephone Number	:	305-653-2039
Fax Number	:

Provider Business Practice Location Address
First Line	:	16190 NE 11TH CT
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4504
Country	:	US
Telephone Number	:	305-944-3883
Fax Number	:	305-354-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/18/2012

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