Organization
MOUNTAIN WEST SURGICAL ASSOCIATES, PROF. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBER GROSS DO (OWNER)
(734) 458-4492
Entity
Organization
Contact information
Practice address
11600 15 MILE RD, SUITE 1, STERLING HEIGHTS, MI 48312-5100
(586) 978-2951
(586) 979-8758
Mailing address
6255 INKSTER RD, SUITE 204, GARDEN CITY, MI 48135-2577
(734) 458-4492
(734) 458-7538
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
RG012468
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0255011765
BCBS
MI
05
—
1427143387
—
MI
Enumeration date
03/11/2008
Last updated
03/18/2013
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