Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 75585 | WI |
NPI | 1013303346 |
---|---|
Provider Name | Dr. Michael Gorelik |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 22/09/2021 |