Provider Demographics
NPI:1972625226
Name:SUDHIR GOSAIN, M.D.
Entity type:Organization
Organization Name:SUDHIR GOSAIN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-899-7641
Mailing Address - Street 1:25101 DETROIT RD STE 450
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2584
Mailing Address - Country:US
Mailing Address - Phone:440-899-7641
Mailing Address - Fax:440-899-7391
Practice Address - Street 1:25101 DETROIT RD STE 450
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2584
Practice Address - Country:US
Practice Address - Phone:440-899-7641
Practice Address - Fax:440-899-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH66798291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory