MEDICARE: IKE B GORMAN DPM.,PC

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	213E00000X	Podiatrist	301	AZ

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	:	1528028115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IKE B GORMAN DPM.,PC

Provider Business Mailing Address
First Line	:	PO BOX 69040
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737
Country	:	US
Telephone Number	:	520-722-5115
Fax Number	:	520-722-0611

Provider Business Practice Location Address
First Line	:	1500 N WILMOT RD
Second Line	:	STE A230
City	:	TUCSON
State	:	AZ
Zip	:	85712-4416
Country	:	US
Telephone Number	:	520-722-5115
Fax Number	:	520-722-0611

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	05/17/2011

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Directions to “ IKE B GORMAN DPM.,PC” Practice Location

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