MEDICARE: DR. MEL KEITH GROSS AU.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
1	231H00000X	Audiologist	A0180	OH

General Provider Information

NPI Number	:	1457353484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEL KEITH GROSS AU.D.

Provider Business Mailing Address
First Line	:	1251 NILLES RD
Second Line	:	STE 7
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-7206
Country	:	US
Telephone Number	:	513-829-7111
Fax Number	:	513-829-7114

Provider Business Practice Location Address
First Line	:	1251 NILLES RD
Second Line	:	STE 7
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-7206
Country	:	US
Telephone Number	:	513-829-7111
Fax Number	:	513-829-7114

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/06/2014

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