MEDICARE: ANTHONY J. GHIDORZI D.O.

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	207P00000X	Emergency Medicine Physician	036089309	IL
2	207P00000X	Emergency Medicine Physician	9666	CA

General Provider Information

NPI Number	:	1427163187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J. GHIDORZI D.O.

Provider Business Mailing Address
First Line	:	1061 ZIEL DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-0576
Country	:	US
Telephone Number	:	773-368-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 ZIEL DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-0576
Country	:	US
Telephone Number	:	773-368-6556
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	02/15/2021

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