Provider Demographics
NPI:1316923444
Name:GORECKI, DAVID J (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:GORECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:901 LINCOLNWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3430
Practice Address - Country:US
Practice Address - Phone:219-362-7506
Practice Address - Fax:219-362-1459
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 070820207RC0000X
IN01038951207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10016541AMedicaid
IN000000514107OtherANTHEM, BCBS
IN10016541AMedicaid
IN151020FFFMedicare PIN