Provider Demographics
NPI:1699747865
Name:GROS, KIMBERLY E (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
Last Name:GROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1621 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1849
Mailing Address - Country:US
Mailing Address - Phone:407-581-4143
Mailing Address - Fax:407-581-4153
Practice Address - Street 1:1621 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1849
Practice Address - Country:US
Practice Address - Phone:407-841-0822
Practice Address - Fax:407-581-4153
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME730662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology