Healthcare Provider Details

I. General information

NPI: 1912053349
Provider Name (Legal Business Name): MICHAEL R GORALKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2874 N CARSON ST SUITE 200
CARSON CITY NV
89706-0177
US

IV. Provider business mailing address

2874 N CARSON ST SUITE 200
CARSON CITY NV
89706-0177
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-9003
  • Fax: 775-883-0959
Mailing address:
  • Phone: 775-883-9003
  • Fax: 775-883-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13288C
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number8584
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: