=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972625226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUDHIR GOSAIN, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 02/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25101 DETROIT RD STE 450
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-899-7641
-----------------------------------------------------
Fax | 440-899-7391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25101 DETROIT RD STE 450
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-899-7641
-----------------------------------------------------
Fax | 440-899-7391
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. SUDHIR GOSAIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 440-899-7641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 66798
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------