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NPI Code Detail

MEDICARE: DR. KELLI XENIA GROSS M.D.

MEDICARE: DR. KELLI XENIA GROSS M.D.
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
1208800000XUrology Physician51571UT

General Provider Information

NPI Number : 1154731685
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLI XENIA GROSS M.D.
Provider Business Mailing Address
First Line : 5126 W DAYBREAK PKWY
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-5994
Country : US
Telephone Number : 801-213-4500
Fax Number :
Provider Business Practice Location Address
First Line : 5126 W DAYBREAK PKWY
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84009-5994
Country : US
Telephone Number : 801-213-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2014
Last Update Date : 01/28/2026

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