Provider Demographics
NPI:1215940911
Name:ROSS, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 900
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5015
Mailing Address - Fax:310-222-5027
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 900
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5015
Practice Address - Fax:310-222-5027
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG47590207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G475900Medicaid
CAWG47590EMedicare ID - Type UnspecifiedPPIN
CAWG47590DMedicare ID - Type UnspecifiedPPIN
CAWG47590CMedicare ID - Type UnspecifiedPPIN
CA00G475900Medicaid