Healthcare Provider Details

I. General information

NPI: 1720080807
Provider Name (Legal Business Name): GREGORY M GOTTSCHLICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 GLENDALE MILFORD RD SUITE 201
CINCINNATI OH
45242-3763
US

IV. Provider business mailing address

4260 GLENDALE MILFORD RD STE 1007
BLUE ASH OH
45242-3763
US

V. Phone/Fax

Practice location:
  • Phone: 513-769-2762
  • Fax: 513-769-2769
Mailing address:
  • Phone: 513-619-9229
  • Fax: 513-386-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-04-8567G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: