MEDICARE: GORO TSUCHIYA MD SC

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	207T00000X	Neurological Surgery Physician	16499	WI

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

General Provider Information

NPI Number	:	1326113309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORO TSUCHIYA MD SC

Provider Business Mailing Address
First Line	:	3535 30TH AVENUE
Second Line	:	SUITE 205
City	:	KENOSHA
State	:	WI
Zip	:	53144-1632
Country	:	US
Telephone Number	:	262-553-9700
Fax Number	:	262-553-9704

Provider Business Practice Location Address
First Line	:	3535 30TH AVENUE
Second Line	:	SUITE 205
City	:	KENOSHA
State	:	WI
Zip	:	53144-1632
Country	:	US
Telephone Number	:	262-553-9700
Fax Number	:	262-553-9704

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GORO TSUCHIYA
Credential	:	MD
Telephone Number	:	262-553-9700

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/21/2010

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