MEDICARE: JOHN GORSUCH AP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP 3470	FL

General Provider Information

NPI Number	:	1184024572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GORSUCH AP

Provider Business Mailing Address
First Line	:	4121 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6741
Country	:	US
Telephone Number	:	407-738-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6741
Country	:	US
Telephone Number	:	407-738-7412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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