Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301500311 | MI |
N | 208600000X | Surgeon | 4301500311 | MI |
Y | 2082S0105X | Plastic Hand Surgeon | 4301500311 | MI |
NPI | 1194088088 |
---|---|
Provider Name | Dr. John A Gorski |
First Address | Warren, MI 48093-2546 |
Second Address | Novi, MI 48375-1884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2012 |
Last Update Date | 24/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301500311 | MI LICENSE (01) | MI |