Organization
GREAT LAKES REHAB, LLC
Active
Other names
Eric T. Gross, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC T GROSS M.D. (PRESIDENT)
(330) 533-0919
Entity
Organization
Contact information
Practice address
6674 TIPPECANOE RD, SUITE # 1, CANFIELD, OH 44406-9149
(330) 533-0919
(330) 533-1732
Mailing address
6674 TIPPECANOE RD, SUITE # 1, CANFIELD, OH 44406-9149
(330) 533-0919
(330) 533-1732
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35 071295
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2118578
—
OH
Enumeration date
03/21/2006
Last updated
12/17/2007
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