Healthcare Provider Details

I. General information

NPI: 1265720262
Provider Name (Legal Business Name): ARON ALAN GORNOWICZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SOUTH CHARLES STREET
ADRIAN MI
49221
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 517-366-5000
  • Fax: 517-366-5002
Mailing address:
  • Phone: 567-585-1918
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101019147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: