MEDICARE: DR. ZAZA GODZIASHVILI 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
1	207L00000X	Anesthesiology Physician	220270	MA
2	207L00000X	Anesthesiology Physician	73175	CT
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	4301075665	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1215936208	OTHER	MI	NPI

General Provider Information

NPI Number	:	1215936208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAZA GODZIASHVILI M.D.

Provider Business Mailing Address
First Line	:	2010 15TH STREET
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708
Country	:	US
Telephone Number	:	989-894-5621
Fax Number	:	989-893-3528

Provider Business Practice Location Address
First Line	:	2010 15TH STREET
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708
Country	:	US
Telephone Number	:	989-894-5621
Fax Number	:	989-893-3528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	06/08/2023

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Directions to “ DR. ZAZA GODZIASHVILI M.D.” Practice Location

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