Provider Demographics
NPI:1699747444
Name:GORSKI, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GORSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IA
Mailing Address - Zip Code:50240-1522
Mailing Address - Country:US
Mailing Address - Phone:641-396-2255
Mailing Address - Fax:641-396-2655
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IA
Practice Address - Zip Code:50240-1522
Practice Address - Country:US
Practice Address - Phone:641-396-2255
Practice Address - Fax:641-396-2655
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0144006Medicaid
IAG48001Medicare UPIN
IA0144006Medicaid