Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 4301036638 | MI |
NPI | 1043268188 |
---|---|
Provider Name | William Stephen Gross |
First Address | Bloomfield Hills, MI 48301 |
Second Address | Bloomfield Hills, MI 48301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B47353 | (02) | MI |