Provider Demographics
NPI:1285639351
Name:GORA, GINA (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:GORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3347 WORMER DR.
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-872-1526
Mailing Address - Fax:248-673-6068
Practice Address - Street 1:6900 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3424
Practice Address - Country:US
Practice Address - Phone:248-855-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066415207QH0002X, 208VP0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301066415OtherCONTROLLED SUBSTANCE
MI454929510Medicaid
BG6223806OtherDEA
MI4301066415OtherCONTROLLED SUBSTANCE
MI454929510Medicaid