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General NPI Number Information
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NPI Number | 1508217969
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Entity Type | Individual
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Provider Name | ANDREW GOSCHKA MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 3990 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2018
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Country | US
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Telephone | 313-745-5111
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Fax | 313-745-3500
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Provider Business Mailing Address
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Address Line | 3990 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2018
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Country | US
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Telephone | 313-745-5111
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Fax | 313-745-3500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01093080A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 4301511496
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License Number State | MI
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