Provider Demographics
NPI:1386695633
Name:GORSKI, DAVID P (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:GORSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 N SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9002
Mailing Address - Country:US
Mailing Address - Phone:608-884-3354
Mailing Address - Fax:608-884-5022
Practice Address - Street 1:11051 N SHERMAN RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9002
Practice Address - Country:US
Practice Address - Phone:608-884-3354
Practice Address - Fax:608-884-5022
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138-023363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2155OtherDEAN HEALTH INSURANCE
WI42900100Medicaid
WIGORSKDAVOtherMERCYCARE
WI1019562OtherPHYSICIANS PLUS
S44746Medicare UPIN
WIGORSKDAVOtherMERCYCARE
WI000654375Medicare PIN