Provider Demographics
NPI:1306069513
Name:JAMES A GROSS MD SC
Entity type:Organization
Organization Name:JAMES A GROSS MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-856-3800
Mailing Address - Street 1:130 S IL ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1620
Mailing Address - Country:US
Mailing Address - Phone:847-856-3800
Mailing Address - Fax:847-856-3803
Practice Address - Street 1:130 S IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1620
Practice Address - Country:US
Practice Address - Phone:847-856-3800
Practice Address - Fax:847-856-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072198207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603690OtherBLUE CROSSBLUE SHIELD IL
IL932590Medicare ID - Type Unspecified
IL31603690OtherBLUE CROSSBLUE SHIELD IL