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General NPI Number Information
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NPI Number | 1942405584
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Entity Type | Individual
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Provider Name | MICHAEL GOMEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 2500 METROHEALTH DR
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 216-957-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 20825 CHAGRIN BLVD APT 6
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City | BEACHWOOD
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State | OH
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Zip | 44122-5333
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Country | US
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Telephone | 440-252-2678
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.097821
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License Number State | OH
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