MEDICARE: DR. ELLIOT 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
1	174400000X	Specialist	G28678	CA

General Provider Information

NPI Number	:	1639153786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT GROSS M.D.

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE.
Second Line	:	#509
City	:	CULVER CITY
State	:	CA
Zip	:	90232
Country	:	US
Telephone Number	:	310-559-4833
Fax Number	:	310-558-0624

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE
Second Line	:	#509
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2751
Country	:	US
Telephone Number	:	310-559-4833
Fax Number	:	310-558-0624

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	11/23/2010

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