Provider Demographics
NPI:1992932941
Name:GROSS, IRINA Y (DPM)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:Y
Last Name:GROSS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:Y
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5017 NOB HILL DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3348
Mailing Address - Country:US
Mailing Address - Phone:440-552-0999
Mailing Address - Fax:440-600-7337
Practice Address - Street 1:200 INDUSTRIAL PKWY STE 4D
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4422
Practice Address - Country:US
Practice Address - Phone:440-552-0999
Practice Address - Fax:440-600-7337
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006413213ES0103X
OH36.003747213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH392950Medicare PIN