Provider Demographics
NPI:1366403487
Name:GROSS, MICHAEL PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 GROOMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7315
Mailing Address - Country:US
Mailing Address - Phone:239-849-4189
Mailing Address - Fax:
Practice Address - Street 1:6491 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2100
Practice Address - Country:US
Practice Address - Phone:239-849-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87241208200000X
VA01012477472082S0105X
MN64499208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTAX IDOther650427479
FL14775Medicare PIN
FLF26323Medicare UPIN