Individual
MR. MICHAEL DAVID GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
400 AVENUE K SE, SUITE 11, WINTER HAVEN, FL 33880-4146
(863) 294-4404
(863) 294-1059
Mailing address
400 AVENUE K, SE, SUITE 11, WINTER HAVEN, FL 33880-4145
(863) 294-4404
(863) 294-1059
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
003304
GA
363AM0700X
Medical Physician Assistant
Primary
PA9101248
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002229B
—
GA
05
—
2907941-00
—
FL
01
—
970021690
RAILROAD MEDICARE
FL
Enumeration date
02/17/2006
Last updated
03/30/2012
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