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NPI Code Detail

MEDICARE: NATHAN GONIK M.D.

MEDICARE:   NATHAN  GONIK  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YP0228XPediatric Otolaryngology Physician4301105847MI

General Provider Information

NPI Number : 1174759815
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN GONIK M.D.
Provider Business Mailing Address
First Line : 3901 BEAUBIEN ST
Second Line : SUITE 2102
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-966-6443
Fax Number : 313-745-0747
Provider Business Practice Location Address
First Line : 3901 BEAUBIEN ST
Second Line : SUITE 2102
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-966-6443
Fax Number : 313-745-0747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2009
Last Update Date : 09/21/2016

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