MEDICARE: GORSI PHYSICIANS GROUP

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1518689017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORSI PHYSICIANS GROUP

Provider Business Mailing Address
First Line	:	467 GRAY AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4813
Country	:	US
Telephone Number	:	312-752-5403
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 GRAY AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4813
Country	:	US
Telephone Number	:	312-752-5403
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAMAILA GORSI
Credential	:	MD
Telephone Number	:	312-752-5403

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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