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NPI Code Detail

MEDICARE: ELISABETH KLOR GROSS MD

MEDICARE: ELISABETH KLOR 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
1207R00000XInternal Medicine PhysicianIL

General Provider Information

NPI Number : 1609879279
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISABETH KLOR GROSS MD
Provider Business Mailing Address
First Line : 1150 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-8160
Country : US
Telephone Number : 773-549-7757
Fax Number : 773-549-1221
Provider Business Practice Location Address
First Line : 1150 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-8160
Country : US
Telephone Number : 773-549-7757
Fax Number : 773-549-1221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 11/21/2007

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