=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346294683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN GUSZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3973 LOOMIS PKWY SUITE A
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-296-8239
-----------------------------------------------------
Fax | 330-296-6528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3973 LOOMIS PKWY SUITE B
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-296-8239
-----------------------------------------------------
Fax | 330-296-6528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35069925G
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------